Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS038899 | PA |
NPI | 1083998918 |
---|---|
Provider Name | Dr. Sandrine Amir Barakat |
First Address | Philadelphia, PA 19103-4523 |
Second Address | Philadelphia, PA 19104-6030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2011 |
Last Update Date | 26/02/2014 |