Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | C10011479 | DE |
Y | 207PP0204X | Pediatric Emergency Physician | MD450594 | PA |
N | 208000000X | Pediatrician | MT198952 | PA |
NPI | 1114212099 |
---|---|
Provider Name | Dr. Stephen M Sandelich |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2011 |
Last Update Date | 28/02/2017 |