Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R215546 | MD |
NPI | 1003311630 |
---|---|
Provider Name | Messanvi M Gozo |
First Address | Middle River, MD 21220-3766 |
Second Address | Easton, MD 21601-3346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 24/05/2019 |