Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT211791 | PA |
Y | 2080P0216X | Pediatric Rheumatologist | MT211791 | PA |
NPI | 1962852699 |
---|---|
Provider Name | Dr. Melissa Argraves |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 26/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MT211791 | MEDICAL LICENSE (01) | PA |