Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD072799L | PA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD072799L | PA |
NPI | 1053388694 |
---|---|
Provider Name | Dr. Melissa Lynn Mckernan Pulliam |
First Address | Lancaster, PA 17603-2964 |
Second Address | Lancaster, PA 17603-2964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 30/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012686220001 | (05) | PA |
I26798 | (02) | PA |