Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | F345952-01 | NY |
NPI | 1003428418 |
---|---|
Provider Name | Meghan Dambach |
First Address | Liverpool, NY 13088-3676 |
Second Address | Liverpool, NY 13088-3629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2020 |
Last Update Date | 18/08/2020 |