Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101056179 | VA |
Y | 2080P0205X | Pediatric Endocrinologist | 0101056179 | VA |
NPI | 1215987854 |
---|---|
Provider Name | Eric O. Gyuricsko |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 09/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019257470001 | (05) | PA |
006734561 | (05) | VA |
2005456000 | (05) | WV |
400196600 | (05) | MD |
790626N | (05) | NC |
G70771 | (02) |