Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD431203 | PA |
NPI | 1043376064 |
---|---|
Provider Name | Charles Stroud Gawthrop JR. |
First Address | Paoli, PA 19301-1620 |
Second Address | Paoli, PA 19301-1620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 19/04/2021 |