Provider Demographics
NPI:1003175688
Name:GOGOL-TAGLIAFERRO, AMANDA (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOGOL-TAGLIAFERRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8530
Mailing Address - Fax:330-543-3731
Practice Address - Street 1:215 W BOWERY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1069
Practice Address - Country:US
Practice Address - Phone:330-543-8530
Practice Address - Fax:330-543-3731
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics