Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 288226 | NY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD467275 | PA |
NPI | 1104098169 |
---|---|
Provider Name | Marisa Cevasco |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288226 | NYS LICENSE (01) | NY |