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General NPI Number Information
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NPI Number | 1154145290
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Entity Type | Organization
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Legal Business Name | GOMEZ YIM & RASTOGI, M.D., P.A.
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 253 LEWIS LN STE 203
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3756
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Country | US
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Telephone | 410-939-0696
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Fax | 410-939-6210
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Provider Business Mailing Address
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Address Line | 602 S ATWOOD RD STE 104
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City | BEL AIR
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State | MD
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Zip | 21014-4198
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Country | US
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Telephone | 410-838-9555
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Fax | 410-836-5056
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Authorized Official
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Title or Position | MD/OWNER
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Name | ROBERT YIM
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Credential | MD
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Telephone | 410-838-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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