Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | RT006820 | PA |
NPI | 1033776984 |
---|---|
Provider Name | Morgan A Herold |
First Address | Selinsgrove, PA 17870-1962 |
Second Address | Selinsgrove, PA 17870-1962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 28/05/2019 |