Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0126001414 | VA |
Y | 213ES0000X | Sports Medicine | 0126001414 | VA |
NPI | 1306260617 |
---|---|
Provider Name | Mrs. Meghan Ashley Gore |
First Address | Winchester, VA 22601 |
Second Address | Winchester, VA 22601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2014 |
Last Update Date | 06/02/2014 |