Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | DS041313 | PA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS041313 | PA |
NPI | 1043736051 |
---|---|
Provider Name | Dr. Miriam Ting |
First Address | Paoli, PA 19301-1751 |
Second Address | Paoli, PA 19301-1751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2017 |
Last Update Date | 27/10/2020 |