Individual
JANICE ANN GAULT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
840 WALNUT ST, SUITE 1240, PHILADELPHIA, PA 19107-5109
(215) 928-3138
(610) 668-7454
Mailing address
1113 BRYNLAWN RD, VILLANOVA, PA 19085-2101
(484) 222-6197
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
25MA06068600
NJ
207W00000X
Ophthalmology Physician
Primary
MD050661L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016296410007
—
PA
05
—
6811108
—
NJ
Enumeration date
10/18/2005
Last updated
05/17/2018
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