| Gonzaga Pediatrics And Family Medicine | |
|
957 National Hwy Lavale MD 21502 | |
| (301) 729-9475 | |
| (301) 729-9474 |
| Full Name | Gonzaga Pediatrics And Family Medicine |
|---|---|
| Speciality | Pediatrics |
| Location | 957 National Hwy, Lavale, Maryland |
| Authorized Official Name and Position | Rommel Gonzaga (CEO) |
| Authorized Official Contact | 3017299475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gonzaga Pediatrics And Family Medicine 957 National Hwy Lavale MD 21502 Ph: (301) 729-9475 | Gonzaga Pediatrics And Family Medicine 957 National Hwy Lavale MD 21502 Ph: (301) 729-9475 |
| NPI Number | 1356684302 |
|---|---|
| Provider Enumeration Date | 03/28/2013 |
| Last Update Date | 08/17/2023 |
| Medicare PECOS PAC ID | 9032340419 |
|---|---|
| Medicare Enrollment ID | O20140327002007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356684302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D39811 (Maryland) | Secondary |
| 208000000X | Pediatrics | D22277 (Maryland) | Primary |
| Provider Name | Denise Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255370524 PECOS PAC ID: 6204871767 Enrollment ID: I20050624000381 |
| Provider Name | Richard H Schlottman |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1851380141 PECOS PAC ID: 2668550245 Enrollment ID: I20080422000894 |
| Provider Name | Michelle Marie Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316119365 PECOS PAC ID: 3072670017 Enrollment ID: I20090319000157 |
| Provider Name | Robustiano J Barrera |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033187000 PECOS PAC ID: 7618019761 Enrollment ID: I20100127000722 |
| Provider Name | Rosario B Gonzaga |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184627457 PECOS PAC ID: 5991936379 Enrollment ID: I20140327002187 |
| Provider Name | April Dawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144992181 PECOS PAC ID: 2961892237 Enrollment ID: I20211130001244 |
| Provider Name | Bernadette Beleho Woueko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427704790 PECOS PAC ID: 4082058441 Enrollment ID: I20240214001265 |
| Provider Name | Theresa Victoria Proctor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447845888 PECOS PAC ID: 2365881356 Enrollment ID: I20240424000965 |
Connie Morris, Crnp, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13106 Winchester Rd Sw Ste 100, Lavale, MD 21502 Phone: 240-362-7249 Fax: 240-362-7285 | |
Anthony J Bollino,jr., M.d., Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 922 National Hwy, Lavale, MD 21502 Phone: 301-729-6531 Fax: 301-729-6897 | |
Upmc Western Maryland Health Services, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1313 National Hwy Ste 680, Lavale, MD 21502 Phone: 240-362-0288 |