Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | OS016578 | PA |
N | 208D00000X | General Practice Physician | C20010658 | DE |
N | 208D00000X | General Practice Physician | OS016578 | PA |
NPI | 1073802591 |
---|---|
Provider Name | Mr. Dustin Daniel Flannery |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 02/05/2018 |