Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 018533 | CT |
NPI | 1710195078 |
---|---|
Provider Name | John H. Mcgowan |
First Address | Mystic, CT 06355-3254 |
Second Address | Mystic, CT 06355-3254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C65056 | (02) |