Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD022661E | PA |
NPI | 1003919507 |
---|---|
Provider Name | Valerie J Cicerone Bossard |
First Address | Philadelphi, PA 19152 |
Second Address | Philadelphi, PA 19152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 26/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B41304 | (02) |