Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | D0089451 | MD |
NPI | 1083069348 |
---|---|
Provider Name | Miranda Gordon-Zigel |
First Address | Philadelphia, PA 19104-5545 |
Second Address | Baltimore, MD 21230-5546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 03/06/2020 |