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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
245 N 15TH ST FL 6, PHILADELPHIA, PA 19102-1101
(215) 762-7916
Mailing address
245 N. 15TH ST., 6TH FLOOR; MS 427, PHILADELPHIA, PA 19102
(215) 762-7916

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MT217905
PA

Other

Enumeration date
06/06/2019
Last updated
06/06/2019
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