Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | NC30162 | NC |
NPI | 1629298872 |
---|---|
Provider Name | Dr. Bernard Gottschalk |
First Address | Wilmington, NC 28401-7661 |
Second Address | Wilmington, NC 28401-7661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C84130 | (02) | NC |