Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 76708 | MA |
NPI | 1114965431 |
---|---|
Provider Name | Jeanne E Gose |
First Address | Salem, MA 01970 |
Second Address | Salem, MA 01970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3103307 | (05) | MA |
A94678 | (02) |