Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD062994L | PA |
Y | 2080A0000X | Adolescent Medicine | MD062994L | PA |
NPI | 1194892414 |
---|---|
Provider Name | Marsha B Novick |
First Address | Hershey, PA 17033-0858 |
Second Address | Harrisburg, PA 17112-3248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 10/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016737750008 | (05) | PA |
G78745 | (02) |