Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD-044386-L | PA |
Y | 208600000X | Surgeon | MD-044386-L | PA |
NPI | 1013905058 |
---|---|
Provider Name | John Meilahn |
First Address | Philadelphia, PA 19118-2722 |
Second Address | Philadelphia, PA 19118-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 17/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012430860001 | (05) | PA |
E47784 | (02) |