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General NPI Number Information
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NPI Number | 1780673137
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Entity Type | Individual
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Provider Name | JANICE ANN GAULT MD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 840 WALNUT ST SUITE 1240
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5109
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Country | US
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Telephone | 215-928-3138
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Fax | 610-668-7454
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Provider Business Mailing Address
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Address Line | 1113 BRYNLAWN RD
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City | VILLANOVA
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State | PA
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Zip | 19085-2101
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Country | US
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Telephone | 484-222-6197
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD050661L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA06068600
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License Number State | NJ
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