Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD071249L | PA |
NPI | 1023077856 |
---|---|
Provider Name | Mythili Seetharaman |
First Address | Boston, MA 02284-8269 |
Second Address | Allentown, PA 18104-9147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 16/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00189905 | (05) | PA |
H73652 | (02) |