Peterside, Iyalla

Peterside, Iyalla is an individual health care provider with primary practice located at 3401 Civic Center Blvd Children'S Hospital Of Philadelphia - Neonatology, Philadelphia PA 19104-4319. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine. Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine is his primary health care specialty. Peterside, Iyalla can be contacted via phone (215) 590-1944.

Contact Information

Primary practice address
3401 Civic Center Blvd Children'S Hospital Of Philadelphia - Neonatology Philadelphia PA 19104-4319
Phone: (215) 590-1944
Fax: (215) 590-4454
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD067897L Pennsylvania
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X MD067897L Pennsylvania

Profile Details

NPI number 1699710178
LBN Legal business name Peterside, Iyalla
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 18th, 2006
Last updated Apr 20th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699710178 NPPES
Pennsylvania MEDICAID 0017940000004
Pennsylvania MEDICAID 8183007

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