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General NPI Number Information
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NPI Number | 1235654286
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Entity Type | Individual
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Provider Name | DOROTEA MUTABDZIC MD
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Gender | Female
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | FOX CHASE CANCER CENTER 333 COTTMAN AVE, DEPT OF SURGICAL ONCOLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19111
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Country | US
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Telephone | 267-269-4588
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Fax |
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Provider Business Mailing Address
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Address Line | DEPARTMENT OF SURGICAL ONCOLOGY 333 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | MD461646
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License Number State | PA
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