Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | OS6969 | FL |
N | 208000000X | Pediatrician | OS6969 | FL |
Y | 208000000X | Pediatrician | OS8052L | PA |
N | 2080P0204X | Pediatric Emergency Doctor | OS6969 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | OS8052L | PA |
NPI | 1790701126 |
---|---|
Provider Name | Miss Abigail Pudpud |
First Address | Atlanta, GA 30384-4112 |
Second Address | Philadelphia, PA 19146-3506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 13/07/2020 |