Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 4301106746 | MI |
Y | 207K00000X | Allergist & Immunologist | MD442011 | PA |
N | 207R00000X | Internist | 4301106746 | MI |
N | 111NI0900X | Internist | 4301106746 | MI |
NPI | 1093973091 |
---|---|
Provider Name | Krista M Todoric |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 19/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1025830110003 | (05) | PA |