Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101272170 | VA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101272170 | VA |
N | 2080P0204X | Pediatric Emergency Doctor | 0101272170 | VA |
NPI | 1003312869 |
---|---|
Provider Name | Joshua Wayne Gollub |
First Address | Norfolk, VA 23507-1910 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 12/07/2021 |