Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | OS-009647L | PA |
NPI | 1538328927 |
---|---|
Provider Name | Dr. Staci Botwin Mulcahy |
First Address | Bethlehem, PA 18017-9429 |
Second Address | Bethlehem, PA 18017-9429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 23/03/2015 |