Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 40072 | KY |
NPI | 1023220092 |
---|---|
Provider Name | Pinky Dalal Gaba |
First Address | Bowling Green, KY 42102-9039 |
Second Address | Bowling Green, KY 42101-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 18/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000564405 | ANTHEM (01) | KY |
7100028070 | (05) | KY |