1831235456 NPI number — DR. FERNANDO SAMPAIO GOES M.D.

Table of content: DR. FERNANDO SAMPAIO GOES M.D. (NPI 1831235456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831235456 NPI number — DR. FERNANDO SAMPAIO GOES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOES
Provider First Name:
FERNANDO
Provider Middle Name:
SAMPAIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1831235456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 N CHARLES ST
Provider Second Line Business Mailing Address:
APT 1113
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21218-1756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-889-5999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N WOLFE ST
Provider Second Line Business Practice Location Address:
MEYER 4-119D
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-287-6382
Provider Business Practice Location Address Fax Number:
410-502-0065
Provider Enumeration Date:
01/30/2007

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: 2084P0800X , with the licence number:  D61712 , 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: 018330000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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