Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 34.011673 | OH |
NPI | 1003175688 |
---|---|
Provider Name | Amanda Gogol-Tagliaferro |
First Address | Akron, OH 44308-1063 |
Second Address | Akron, OH 44308-1069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 03/03/2021 |