Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 0420009610 | VT |
N | 207VG0400X | Gynecologist | 1994931 | NY |
Y | 207VX0201X | Gynecologic Oncologist | 0420009610 | VT |
N | 207VX0201X | Gynecologic Oncologist | 1994931 | NY |
NPI | 1467448787 |
---|---|
Provider Name | Dr. Gamal H Eltabbakh |
First Address | South Burlington, VT 05403-7612 |
Second Address | South Burlington, VT 05403-7612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 23/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01760585 | (05) | NY |
F96992 | (02) | |
OVN1692 | (05) | VT |