Individual
CAROLYN MIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104
(215) 662-6503
Mailing address
3400 SPRUCE ST, 6 FOUNDERS, PHILADELPHIA, PA 19104-4206
(215) 662-6503
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
MD036040E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018537280001
—
PA
Enumeration date
06/22/2006
Last updated
05/14/2012
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