Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2010-01247 | NC |
N | 207V00000X | Obstetrician & Gynecologist | 241003-1 | NY |
Y | 207VX0000X | Obstetrician | MB86253 | NJ |
NPI | 1306070719 |
---|---|
Provider Name | Myra Cummings Mabry |
First Address | Lake Ariel, PA 18436-3252 |
Second Address | Lake Ariel, PA 18436-3252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 01/10/2013 |