Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2009-01001 | NC |
Y | 2080P0210X | Pediatric Nephrologist | 0101249088 | VA |
NPI | 1912054719 |
---|---|
Provider Name | Susan Fowler Guelich |
First Address | Roanoke, VA 24014-1010 |
Second Address | Roanoke, VA 24014-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 12/04/2016 |