Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | OT015672 | PA |
NPI | 1023420361 |
---|---|
Provider Name | Elise Scoggin |
First Address | Allentown, PA 18103-6372 |
Second Address | Allentown, PA 18103-6372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 10/05/2018 |