Individual
DR. GITY BANAN ETEMAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15 WISTAR RD, VILLANOVA, PA 19085-1512
(484) 433-2339
Mailing address
15 WISTAR RD, VILLANOVA, PA 19085-1512
(484) 433-2339
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD031935L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208000000X
TOXINOMY
—
01
—
MD031935L
MEDICAL LICENSE
PA
Enumeration date
03/07/2010
Last updated
03/07/2010
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