Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD421918 | PA |
Y | 2080P0202X | Pediatric Cardiologist | MD421918 | PA |
NPI | 1033257720 |
---|---|
Provider Name | Michael Quartermain |
First Address | Philadelphia, PA 19107 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 14/09/2016 |