Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD069638L | PA |
NPI | 1023036704 |
---|---|
Provider Name | Tracy S D'entremont |
First Address | Philadelphia, PA 19104 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 14/03/2013 |