Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME139419 | FL |
Y | 2080P0214X | Pediatric Pulmonologist | MT219698 | PA |
NPI | 1043673106 |
---|---|
Provider Name | Jelte Kelchtermans |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2016 |
Last Update Date | 24/06/2020 |