Provider Demographics
NPI:1487639142
Name:GOMEZ, PATRICIA S (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:S
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:ROZARIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10067
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20898-9998
Mailing Address - Country:US
Mailing Address - Phone:301-527-1650
Mailing Address - Fax:301-527-8752
Practice Address - Street 1:15245 SHADY GROVE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:301-527-1650
Practice Address - Fax:301-527-8752
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426458207R00000X
MDD63232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1743594OtherHIGHMARK BLUE SHIELD
PA1012615880001Medicaid
50050205OtherCAP BLUE CROSS
PA1012615880001Medicaid
PA090930Medicare PIN
I29524Medicare UPIN