MEDICARE: ERNESTO R GONZALEZ M.D.

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	207RP1001X	Pulmonary Disease Physician	0101051054	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	290008474	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7015005	OTHER	VA	MAMSI
2	271532	OTHER	VA	ANTHEM PROVIDER NUMBER
3	4800711	OTHER	VA	UNITED HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	271532	OTHER	VA	ANTHEM HEALTHKEEPERS
6	71865	OTHER	VA	SOUTHERN HEALTH
7	006895400	OTHER	VA	BLACK LUNG PROVIDER NUMBE
8	021787	OTHER	VA	CIGNA PROVIDER NUMBER
9	11795	OTHER	VA	CARENET PROVIDER NUMBER
10	557515	OTHER	VA	AETNA NON HMO

General Provider Information

NPI Number	:	1588680318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO R GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	1000 BOULDERS PKWY
Second Line	:	SUITE 102
City	:	RICHMOND
State	:	VA
Zip	:	23225-5545
Country	:	US
Telephone Number	:	804-320-4243
Fax Number	:	804-622-0552

Provider Business Practice Location Address
First Line	:	7486 RIGHT FLANK RD STE 100
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3834
Country	:	US
Telephone Number	:	804-320-4243
Fax Number	:	804-622-0552

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/26/2023

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