Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MD456620 | PA |
NPI | 1285800854 |
---|---|
Provider Name | Dr. Xiaomang Ba Stickles |
First Address | Wynnewood, PA 19096-3450 |
Second Address | Wynnewood, PA 19096-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 12/09/2016 |