Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 35052334 | OH |
NPI | 1144204538 |
---|---|
Provider Name | Mrs. Susan Holliday Barde |
First Address | Dayton, OH 45409-1332 |
Second Address | Dayton, OH 45409-1332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A16130 | (02) |