MEDICARE: MARIA-ANNETTE GOUMAS RN

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
1	163WA2000X	Administrator Registered Nurse	R061733	MD

General Provider Information

NPI Number	:	1255453098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA-ANNETTE GOUMAS RN

Provider Business Mailing Address
First Line	:	22 SAINT ANDREWS RD
Second Line	:
City	:	SEVERNA PARK
State	:	MD
Zip	:	21146-1420
Country	:	US
Telephone Number	:	410-987-4244
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 HARRY S TRUMAN PKWY
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7031
Country	:	US
Telephone Number	:	410-222-7145
Fax Number	:	410-222-4035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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