Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | L5330 | TX |
NPI | 1275625949 |
---|---|
Provider Name | Mary Lynn Elizabeth Fecile |
First Address | Hershey, PA 17033-0854 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 12/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
153991803 | (05) | TX |
H74760 | (02) | TX |
MD437434 | MEDICAL LICENSE (01) | PA |