Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD030988E | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD030988E | PA |
NPI | 1306852645 |
---|---|
Provider Name | Kathy N Shaw |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001091402 | (05) | PA |
2276801 | (05) | NJ |
C32811 | (02) |