Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | MT216975 | PA |
NPI | 1275038895 |
---|---|
Provider Name | Heather Boas |
First Address | Philadelphia, PA 19147-1156 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 19/06/2021 |