Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 5917 | NH |
N | 2080A0000X | Adolescent Medicine | 5917 | NH |
NPI | 1265491443 |
---|---|
Provider Name | Gwendolyn Gladstone |
First Address | Exeter, NH 03833-0655 |
Second Address | Exeter, NH 03833-2520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 14/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000846 | (05) | NH |
G08073 | (02) |