Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD424636 | PA |
NPI | 1013091040 |
---|---|
Provider Name | Jane Marie Prosser |
First Address | Philadelphia, PA 19182-8065 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 11/02/2022 |