Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD033507E | PA |
Y | 207VX0201X | Gynecologic Oncologist | MD033507E | PA |
NPI | 1063476190 |
---|---|
Provider Name | Stephanie Angela King |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 12/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001124989 | (05) | PA |
0011249890006 | (05) | PA |
F13413 | (02) | |
F13413 | (02) | PA |