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NPI Code Detail

MEDICARE: AMITHA GONA M.D

MEDICARE: AMITHA GONA M.D
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
1207RR0500XRheumatology PhysicianMDOR

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 : 1053611566
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMITHA GONA M.D
Provider Business Mailing Address
First Line : 875 OAK ST SE STE 4030
Second Line :
City : SALEM
State : OR
Zip : 97301-3984
Country : US
Telephone Number : 503-561-6444
Fax Number : 503-561-6440
Provider Business Practice Location Address
First Line : 3025 RYAN DR SE
Second Line :
City : SALEM
State : OR
Zip : 97301-5057
Country : US
Telephone Number : 503-485-0350
Fax Number : 503-561-6442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2010
Last Update Date : 03/13/2023

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