Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | MD037734E | PA |
NPI | 1023110152 |
---|---|
Provider Name | Lisa K. Jablon |
First Address | Philadelphia, PA 19120-2421 |
Second Address | Philadelphia, PA 19115-2185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255425 | (05) | PA |
E45232 | (02) | PA |