Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | D86714 | MD |
N | 2086S0129X | Vascular Surgeon | MD474306 | PA |
NPI | 1144514340 |
---|---|
Provider Name | Junyan Gu |
First Address | Hagerstown, MD 21742-6799 |
Second Address | Hagerstown, MD 21742-6799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 18/08/2021 |