Healthcare Provider Details

I. General information

NPI: 1982145231
Provider Name (Legal Business Name): ERNESTO SIGIFREDO ROBALINO GONZAGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD FL 7
PHILADELPHIA PA
19104-5163
US

IV. Provider business mailing address

1830 E MONUMENT ST STE 431
BALTIMORE MD
21287-0020
US

V. Phone/Fax

Practice location:
  • Phone: 203-895-6260
  • Fax:
Mailing address:
  • Phone: 203-895-6260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD92297
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME144163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: