Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS037462 | PA |
NPI | 1114158292 |
---|---|
Provider Name | Mariam Kamel Labib- Soliman |
First Address | Philadelphia, PA 19130-4075 |
Second Address | Wilmington, DE 19810-3650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 16/05/2018 |