Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35-079881 | OH |
N | 111NI0900X | Internist | 35-079881 | OH |
N | 207RP1001X | Pulmonary Disease | 35-079881 | OH |
N | 207RP1001X | Pulmonary Disease | 47924 | TN |
N | 208000000X | Pediatrician | 35-079881 | OH |
N | 2080P0214X | Pediatric Pulmonologist | 35-079881 | OH |
N | 2080P0214X | Pediatric Pulmonologist | 47924 | TN |
Y | 2080P0214X | Pediatric Pulmonologist | MD466754 | PA |
NPI | 1184672396 |
---|---|
Provider Name | Lisa Rosenthal Young |
First Address | Philadelphia, PA 19107-3377 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 03/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200539670 | (05) | IN |
2592672 | (05) | OH |
64113665 | (05) | KY |
I43862 | (02) |