Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS006362E | PA |
NPI | 1164648846 |
---|---|
Provider Name | Dr. Mitchell S Mednick |
First Address | Brentwood, TN 37027-5005 |
Second Address | Philadelphia, PA 19147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 13/08/2018 |