Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | D0064339 | MD |
Y | 2080P0205X | Pediatric Endocrinologist | MD60420939 | WA |
NPI | 1316113335 |
---|---|
Provider Name | Dr. Radha Nandagopal |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2008 |
Last Update Date | 23/06/2021 |