Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD431875 | PA |
N | 207KA0200X | Allergist | MD431875 | PA |
N | 207R00000X | Internist | MD431875 | PA |
N | 111NI0900X | Internist | MD431875 | PA |
NPI | 1407873441 |
---|---|
Provider Name | Patricia A Takach |
First Address | Philadelphia, PA 19104-2640 |
Second Address | Philadelphia, PA 19104-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I09938 | (02) |