Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD057263L | PA |
NPI | 1225106461 |
---|---|
Provider Name | Dr. Gail Marie Glushko |
First Address | Fort Gordon, GA 30905-5650 |
Second Address | Fort Gordon, GA 30905-5650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD 000 | (02) |