Healthcare Provider Details

I. General information

NPI: 1821094806
Provider Name (Legal Business Name): DENIZ O GOSS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DISCOVERY DRIVE
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

501 DISCOVERY DR
CHESAPEAKE VA
23320-3843
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-5145
  • Fax: 757-436-2480
Mailing address:
  • Phone: 757-547-5145
  • Fax: 757-312-0216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110001438
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: