Healthcare Provider Details

I. General information

NPI: 1154145290
Provider Name (Legal Business Name): GOMEZ YIM & RASTOGI, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 LEWIS LN STE 203
HAVRE DE GRACE MD
21078-3756
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 410-939-0696
  • Fax: 410-939-6210
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
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT YIM
Title or Position: MD/OWNER
Credential: MD
Phone: 410-838-9555