NPI | 1730664012 |
---|---|
Entity Type | Organization |
Authorized Contact | COURTNEY AINSWORTH IVESS Associate Director, Credentialing 571-366-8831 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine |
Additional Taxonomies | 208000000X Pediatrics |
Enumeration Date | 2018-10-02 |
Last Update Date | 2018-10-02 |