Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD439247 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD439247 | PA |
NPI | 1164688735 |
---|---|
Provider Name | Maya Augustine Jones |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 16/04/2013 |