Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | L-243768 | MA |
N | 111NI0900X | Internist | L-243768 | MA |
Y | 207RP1001X | Pulmonary Disease | MD451313 | PA |
NPI | 1043530512 |
---|---|
Provider Name | Jessica A Palakshappa |
First Address | Philadelphia, PA 19104-5127 |
Second Address | Philadelphia, PA 19104-5127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 08/05/2017 |