Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MT202501 | PA |
NPI | 1003168246 |
---|---|
Provider Name | Ms. Amman Hassan |
First Address | Philadelphia, PA 19141-3018 |
Second Address | Philadelphia, PA 19141-3018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2012 |
Last Update Date | 11/10/2012 |