Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD017599E | PA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD017599E | PA |
NPI | 1003855727 |
---|---|
Provider Name | Robert S. Wimmer |
First Address | Philadelphia, PA 19141-3018 |
Second Address | Philadelphia, PA 19141-3018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B34823 | (02) | PA |