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Individual

AMANDA VAN PELT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3401 CIVIC CENTER BLVD, 9NW, ROOM 55, PHILADELPHIA, PA 19104-4319
(215) 590-1220
Mailing address
3401 CIVIC CENTER BLVD, 9NW, ROOM 55, PHILADELPHIA, PA 19104-4319
(215) 590-1220

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD460801
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1033083240001
PA
Enumeration date
05/15/2014
Last updated
04/08/2019
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