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General NPI Number Information
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NPI Number | 1245294610
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Entity Type | Individual
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Provider Name | CARMEN LAURA GONZALEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 78 MEDICAL CENTER DRIVE HEART & VASCULAR CENTER, FLR 2
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City | FISHERSVILLE
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State | VA
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Zip | 22939
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Country | US
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Telephone | 540-245-7190
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Fax | 540-245-7191
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Provider Business Mailing Address
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Address Line | PO BOX 388
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City | FISHERSVILLE
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State | VA
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Zip | 22939-0388
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Country | US
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Telephone | 540-245-7190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | M-10202
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0101039166
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License Number State | VA
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