Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD023587E | PA |
Y | 2080P0201X | Pediatric Allergist | MD023587E | PA |
NPI | 1215959036 |
---|---|
Provider Name | Steven D Douglas |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-3365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 12/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000665812 | (05) | PA |
0590002 | (05) | NJ |
C32426 | (02) |