Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 25MA10664500 | NJ |
Y | 207KA0200X | Allergist | MD468870 | PA |
N | 207R00000X | Internist | MD468870 | PA |
N | 111NI0900X | Internist | MD468870 | PA |
NPI | 1598966707 |
---|---|
Provider Name | Dr. Neetu B Vasu |
First Address | Philadelphia, PA 19103-6212 |
Second Address | Philadelphia, PA 19103-6212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 01/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D0074868 | MD LICENSE (01) | MD |