Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0216X | Pediatric Rheumatologist | 62759 | NJ |
Y | 2080P0216X | Pediatric Rheumatologist | 66643 | MN |
NPI | 1154341147 |
---|---|
Provider Name | Elizabeth Chalom |
First Address | Saint Paul, MN 55101-2507 |
Second Address | Saint Paul, MN 55101-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 27/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6866808 | (05) | NJ |
G22593 | (02) | NJ |