Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | MT215096 | PA |
NPI | 1073991329 |
---|---|
Provider Name | Michael Triebwasser |
First Address | Philadelphia, PA 19104 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 19/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MT215096 | MEDICAL LICENSE (01) | PA |