Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD431597 | PA |
Y | 2080P0210X | Pediatric Nephrologist | MD431597 | PA |
NPI | 1568660488 |
---|---|
Provider Name | Michelle Denburg |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 18/04/2013 |