Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD469416 | PA |
N | 2080P0208X | Pediatric Infectious Diseases | MD469416 | PA |
NPI | 1326324609 |
---|---|
Provider Name | Dr. Jaya Goswami |
First Address | Silver Spring, MD 20906-6722 |
Second Address | Silver Spring, MD 20906-6722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IL |