Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | RT007144 | PA |
NPI | 1225662620 |
---|---|
Provider Name | Madison Lohr |
First Address | Philadelphia, PA 19147-6203 |
Second Address | Philadelphia, PA 19121-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2020 |
Last Update Date | 25/02/2020 |