MEDICARE: DR. JOEL LEE GOOZH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D16495	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1275518565	OTHER		NPI IDENTIFIER

General Provider Information

NPI Number	:	1275518565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL LEE GOOZH MD

Provider Business Mailing Address
First Line	:	PO BOX 157
Second Line	:
City	:	ASHTON
State	:	MD
Zip	:	20861-0157
Country	:	US
Telephone Number	:	301-570-9700
Fax Number	:	301-260-2838

Provider Business Practice Location Address
First Line	:	10401 OLD GEORGETOWN RD
Second Line	:	SUITE 104
City	:	BETHESDA
State	:	MD
Zip	:	20814-1911
Country	:	US
Telephone Number	:	301-897-2757
Fax Number	:	301-260-2838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	10/17/2007

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