Individual
JAN MARIE GOPLERUD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
ERIE AVE AT FRONT ST, PHILADELPHIA, PA 19134
(215) 427-5202
(215) 427-8192
Mailing address
109 GRACE ST, MONT CLARE, PA 19453-5071
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD 028755E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010139700007
—
PA
Enumeration date
05/04/2006
Last updated
07/08/2007
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