Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD421690 | PA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD421690 | PA |
NPI | 1457372153 |
---|---|
Provider Name | Miriam Natasa Lango |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019565920007 | (05) | PA |
H83058 | (02) | PA |