Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT190249 | PA |
Y | 2084N0402X | Child Neurologist | MD041530 | DC |
NPI | 1376740746 |
---|---|
Provider Name | Dr. Diana Bharucha-Goebel |
First Address | Baltimore, MD 21297-3215 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 26/07/2013 |