1720070261 NPI number — DAVID A GOORAY MD

Table of content: DAVID A GOORAY MD (NPI 1720070261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720070261 NPI number — DAVID A GOORAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOORAY
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1720070261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/31/2006
NPI Reactivation Date:
04/04/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 MERCANTILE LN
Provider Second Line Business Mailing Address:
SUITE 217
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-5376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-583-7770
Provider Business Mailing Address Fax Number:
301-583-9414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 MERCANTILE LN
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774-5376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-583-7770
Provider Business Practice Location Address Fax Number:
301-583-9414
Provider Enumeration Date:
08/19/2005

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: 207RC0000X , with the licence number:  D0028195 , 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: 377631000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com