Healthcare Provider Details

I. General information

NPI: 1023115326
Provider Name (Legal Business Name): DENISE RENEE GOOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7503 GREENWAY CENTER DR
GREENBELT MD
20770-3508
US

IV. Provider business mailing address

2234 COLONIAL BLVD MANAGED CARE DEPT
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 301-446-3540
  • Fax: 301-446-3543
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD0063896
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0063896
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: