MEDICARE: GONCHAROV MEDICAL, P.C.

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	207V00000X	Obstetrics & Gynecology Physician	269283	NY

General Provider Information

NPI Number	:	1831580091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONCHAROV MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	225 SAINT JOHNS PL # PLACEC
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3405
Country	:	US
Telephone Number	:	718-517-8833
Fax Number	:	347-529-5296

Provider Business Practice Location Address
First Line	:	225 SAINT JOHNS PL # PLACEC
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3405
Country	:	US
Telephone Number	:	718-517-8833
Fax Number	:	646-843-7617

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIMITRY GONCHAROV
Credential	:
Telephone Number	:	212-201-1217

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	08/20/2024

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