Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 0101057812 | VA |
N | 207VG0400X | Gynecologist | 0101057812 | VA |
NPI | 1194750414 |
---|---|
Provider Name | Jeffrey A Welgoss |
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 | 12/07/2006 |
Last Update Date | 03/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001775YPA1 | MEDICARE ID (01) | VA |
E55023 | (02) | VA |