Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 259432 | NY |
N | 208600000X | Surgeon | 259432 | NY |
Y | 2086S0129X | Vascular Surgeon | MD430967 | PA |
NPI | 1093965329 |
---|---|
Provider Name | Elizabeth L. Detschelt |
First Address | Greensburg, PA 15601-8153 |
Second Address | Greensburg, PA 15601-2775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 26/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1030107830001 | (05) | PA |