Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC005776 | PA |
NPI | 1366555963 |
---|---|
Provider Name | Heidi Mandel |
First Address | Narberth, PA 19072-1624 |
Second Address | Narberth, PA 19072-1624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BM8870861 | DEA (01) | PA |