Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | OS012497 | PA |
NPI | 1083836464 |
---|---|
Provider Name | Marie O'brien |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18103-3694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 18/11/2015 |