Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD054953L | PA |
NPI | 1003897067 |
---|---|
Provider Name | Melissa Brodsky |
First Address | Philadelphia, PA 19102 |
Second Address | Philadelphia, PA 19102-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 16/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G12138 | (02) |