| NPI | 1740500024 |
|---|---|
| Former Name | MARYBETH ROSE CONCANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 276614) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276614) |
| 207R00000X Internal Medicine (Licence: PA MT197257) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2023-04-28 |