| Elena L Goncharova Md Pc | |
|
425 E 5350 S Ste 335 Ogden UT 84405-6946 | |
| (801) 475-5100 | |
| (801) 475-8580 |
| Full Name | Elena L Goncharova Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 425 E 5350 S, Ogden, Utah |
| Authorized Official Name and Position | Elena L Goncharova (PRESIDENT) |
| Authorized Official Contact | 8014755100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elena L Goncharova Md Pc Po Box 150610 Ogden UT 84415-0610 Ph: (801) 476-9200 | Elena L Goncharova Md Pc 425 E 5350 S Ste 335 Ogden UT 84405-6946 Ph: (801) 475-5100 |
| NPI Number | 1912102997 |
|---|---|
| Provider Enumeration Date | 06/19/2007 |
| Last Update Date | 05/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912102997 | NPI | - | NPPES |
| $$$$$$$$$ | Other | OWNERS SSN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 53786511205 (Utah) | Primary |
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