Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 0101242867 | VA |
NPI | 1356498893 |
---|---|
Provider Name | Gaylord Scott Rose |
First Address | Annandale, VA 22003-6800 |
Second Address | Annandale, VA 22003-6800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 21/11/2013 |