Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 222610 | NC |
N | 2084N0402X | Child Neurologist | G1413 | TX |
N | 2084N0402X | Child Neurologist | G49144 | CA |
NPI | 1093726945 |
---|---|
Provider Name | Dr. Sidney Maloch Gospe JR. |
First Address | Durham, NC 27712-2991 |
Second Address | Durham, NC 27712-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C59224 | (02) |