Healthcare Provider Details

I. General information

NPI: 1245294610
Provider Name (Legal Business Name): CARMEN LAURA GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MEDICAL CENTER DRIVE HEART & VASCULAR CENTER, FLR 2
FISHERSVILLE VA
22939
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7190
  • Fax: 540-245-7191
Mailing address:
  • Phone: 540-245-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM-10202
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101039166
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: