Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | D0039091 | MD |
NPI | 1376974139 |
---|---|
Provider Name | Peter Vink |
First Address | Glenside, PA 19038-1421 |
Second Address | Glenside, PA 19038-1421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2013 |
Last Update Date | 04/12/2013 |