Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD065784L | PA |
N | 2080P0202X | Pediatric Cardiologist | MD065784L | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MD065784L | PA |
NPI | 1174543078 |
---|---|
Provider Name | Sarah Tabbutt |
First Address | Philadelphia, PA 19103-1443 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7592507 | (05) | NJ |
G20137 | (02) | PA |