Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD418591 | PA |
NPI | 1043234438 |
---|---|
Provider Name | Dr. Sophia Moldavsky |
First Address | Bryn Mawr, PA 19010-3118 |
Second Address | Bryn Mawr, PA 19010-3118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 01/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I4986 | (02) | PA |