Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | OS019788 | PA |
NPI | 1013396944 |
---|---|
Provider Name | Shannon Mcvey Wiedersum |
First Address | Doylestown, PA 18901-2408 |
Second Address | Doylestown, PA 18901-2408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 05/11/2020 |