1487639142 NPI number — DR. PATRICIA S GOMEZ MD

Table of content: DR. PATRICIA S GOMEZ MD (NPI 1487639142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487639142 NPI number — DR. PATRICIA S GOMEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOMEZ
Provider First Name:
PATRICIA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROZARIO
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487639142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20898-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-527-1650
Provider Business Mailing Address Fax Number:
301-527-8752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15245 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-527-1650
Provider Business Practice Location Address Fax Number:
301-527-8752
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD426458 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: D63232 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1743594 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012615880001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50050205 . This is a "CAP BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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