Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101239789 | VA |
N | 2080P0204X | Pediatric Emergency Doctor | 0101239789 | VA |
NPI | 1134169618 |
---|---|
Provider Name | Jennifer L. Galiotos |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 30/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010275202 | (05) | VA |
I53857 | (02) |