Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MB10091700 | NJ |
N | 208000000X | Pediatrician | C20010621 | DE |
Y | 208000000X | Pediatrician | OS16648 | PA |
N | 2080P0207X | Pediatric Hematology-Oncologist | OS17029 | FL |
NPI | 1164748554 |
---|---|
Provider Name | Renee Gresh |
First Address | Rockland, DE 19732-0191 |
Second Address | Philadelphia, PA 19107-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2010 |
Last Update Date | 28/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102893829 | (05) | PA |