Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD011583E | PA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD011583E | PA |
NPI | 1295767309 |
---|---|
Provider Name | Michael T Mennuti |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000661653 | (05) | PA |
B40264 | (02) | PA |