Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD051423L | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD051423L | PA |
NPI | 1144234618 |
---|---|
Provider Name | Kevin C Osterhoudt |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 24/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001603681 | (05) | PA |
7120109 | (05) | NJ |
G45461 | (02) | PA |