Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MT217659 | PA |
NPI | 1003474107 |
---|---|
Provider Name | Julianne Mcglynn |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2019 |
Last Update Date | 06/05/2020 |