Stormie Rae Gough, DO
Pediatrics in Allentown, PA. Individual provider (NPI-1).
NPI number1164045209
StatusActive
Last updated in NPPESAug 10, 2023
Details
- NPI
- 1164045209
- Entity type
- Individual (NPI-1)
- Name
- Stormie Rae Gough
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 23, 2020
- Certification date
- Aug 10, 2023
- Last updated
- Aug 10, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | OS022997 | PA | Yes |
| 208000000X | Pediatrics | OT020219 | PA | |
| 2080P0204X | Pediatrics, Pediatric Emergency Medicine | OS022997 | PA |
Other names
- Stormie Rae Wagner (Former Name)
Practice location
1200 S Cedar Crest Blvd Fl 6Allentown, PA 18103-6202
Phone 610-402-7712
Mailing address
1200 S Cedar Crest BlvdAllentown, PA 18103-6202
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