Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD070437L | PA |
N | 207VX0000X | Obstetrician | MD070437L | PA |
NPI | 1376523977 |
---|---|
Provider Name | Dr. Patricia A Boken |
First Address | Philadelphia, PA 19104-2612 |
Second Address | Philadelphia, PA 19104-2612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 04/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001797941 | (05) | PA |
232359401 | MAIN LINE HEALTHCARE (01) | PA |
F43588 | (02) |