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NPI Code Detail

MEDICARE: DR. DIEGO ALONSO GOMEZ MD

MEDICARE: DR. DIEGO ALONSO GOMEZ MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist0101044147VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003815408
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIEGO ALONSO GOMEZ MD
Provider Business Mailing Address
First Line : 1139 E HIGH ST
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22902-4856
Country : US
Telephone Number : 434-817-8484
Fax Number : 434-817-8490
Provider Business Practice Location Address
First Line : 1139 E HIGH ST
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22902-4856
Country : US
Telephone Number : 434-817-8484
Fax Number : 434-817-8490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 10/10/2022

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