Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | R8310 | MO |
Y | 2080P0201X | Pediatric Allergist | MD432067 | PA |
NPI | 1205827490 |
---|---|
Provider Name | James Corry |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-3365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 12/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2722V34311 | HEALTHCARE USA (01) | |
A13917 | (02) | MO |