Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MA061473 | PA |
N | 207N00000X | Dermatologist | OA005197 | PA |
NPI | 1033733670 |
---|---|
Provider Name | Fatoumata Haidara Camara |
First Address | Philadelphia, PA 19128-1503 |
Second Address | Bala Cynwyd, PA 19004-1723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2020 |
Last Update Date | 29/05/2020 |