Healthcare Provider Details

I. General information

NPI: 1720070261
Provider Name (Legal Business Name): DAVID A GOORAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date: 03/31/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

1450 MERCANTILE LN SUITE 217
LARGO MD
20774-5376
US

IV. Provider business mailing address

1450 MERCANTILE LN SUITE 217
LARGO MD
20774-5376
US

V. Phone/Fax

Practice location:
  • Phone: 301-583-7770
  • Fax: 301-583-9414
Mailing address:
  • Phone: 301-583-7770
  • Fax: 301-583-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0028195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: