Individual
PETAR MAMULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILA - GASTRO & NUTRITION, PHILADELPHIA, PA 19104-4319
(215) 590-3247
(215) 590-3606
Mailing address
100 E PENN SQ, 9TH FLOOR, PHILADELPHIA, PA 19107-3323
(267) 425-9232
(267) 425-9299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD065396L
PA
2080P0206X
Pediatric Gastroenterology Physician
Primary
MD065396L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001847506
—
PA
05
—
8530301
—
NJ
Enumeration date
08/07/2006
Last updated
04/15/2013
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