Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD047051L | PA |
Y | 2080P0208X | Pediatric Infectious Diseases | MD047051L | PA |
NPI | 1619997129 |
---|---|
Provider Name | Susan E Coffin |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 19/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001613552 | (05) | PA |
7120206 | (05) | NJ |
G45457 | (02) |