Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT201169 | PA |
Y | 2080P0205X | Pediatric Endocrinologist | MD454379 | PA |
NPI | 1083977342 |
---|---|
Provider Name | Mary Vajravelu |
First Address | Pittsburgh, PA 15224 |
Second Address | Pittsburgh, PA 15224-1334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1034873410002 | (05) | PA |