Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | MA058931 | PA |
NPI | 1245745785 |
---|---|
Provider Name | Ericka Blake Lias |
First Address | Pittsburgh, PA 15224 |
Second Address | Pittsburgh, PA 15224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 08/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
363A00000X | (05) | PA |