Healthcare Provider Details

I. General information

NPI: 1407980717
Provider Name (Legal Business Name): GOMEZ YIM & RASTOGI, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S ATWOOD RD STE 104
BEL AIR MD
21014-4198
US

IV. Provider business mailing address

602 S. ATWOOD ROAD SUITE 104
BEL AIR MD
21014
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9555
  • Fax: 410-836-5056
Mailing address:
  • Phone: 410-838-9555
  • Fax: 410-836-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PHILLIP YIM I
Title or Position: OWNER
Credential: M.D.
Phone: 410-838-9555