Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD438154 | PA |
Y | 207RA0401X | Internist - Addiction Medicine | 036.144684 | IL |
NPI | 1083906382 |
---|---|
Provider Name | Gagandeep Goyal |
First Address | Monroeville, PA 15146-1754 |
Second Address | Loves Park, IL 61111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2011 |
Last Update Date | 20/06/2018 |