Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS021083 | PA |
NPI | 1003301417 |
---|---|
Provider Name | Salma Mohammadi Green |
First Address | Annville, PA 17003-6500 |
Second Address | Annville, PA 17003-6500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 13/07/2021 |