Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 0101047406 | VA |
NPI | 1043295447 |
---|---|
Provider Name | Gloria Ann Grover |
First Address | Manassas, VA 20110-4404 |
Second Address | Manassas, VA 20110-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F42299 | (02) |