Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35.120771 | OH |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MT205506 | PA |
NPI | 1235455445 |
---|---|
Provider Name | Jessica Foster |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 10/12/2014 |