Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101045398 | VA |
Y | 2080P0214X | Pediatric Pulmonologist | 0101045398 | VA |
NPI | 1053361683 |
---|---|
Provider Name | Marilyn A. Gowen |
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 | 12/05/2006 |
Last Update Date | 09/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000975001 | (05) | DE |
0018725450001 | (05) | PA |
006722067 | (05) | VA |
109921300 | (05) | MD |
6700074000 | (05) | WV |
890540I | (05) | NC |
C84135 | (02) |