Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD043624E | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MD043624E | PA |
NPI | 1235149113 |
---|---|
Provider Name | Maria Luiza Albuquerque |
First Address | Danville, PA 17822-4903 |
Second Address | Scranton, PA 18510-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 01/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012390300 | (05) | PA |
H79500 | (02) | PA |