Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 2021-00492 | NC |
N | 207SG0201X | Clinical Genetics (M.D.) | OT017330 | PA |
NPI | 1396199543 |
---|---|
Provider Name | Rose Guo |
First Address | Collingswood, NJ 08108-3132 |
Second Address | Greensboro, NC 27401-1210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 07/12/2021 |