MEDICARE: DR. DEBORAH GOFREED 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
1	207RP1001X	Pulmonary Disease Physician	0101036617	VA
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	0101036617	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1982792420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH GOFREED M.D.

Provider Business Mailing Address
First Line	:	2901 TELESTAR CT STE 300
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-1263
Country	:	US
Telephone Number	:	703-591-1688
Fax Number	:	703-591-1445

Provider Business Practice Location Address
First Line	:	1005 N GLEBE RD # 705
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-5718
Country	:	US
Telephone Number	:	703-524-7202
Fax Number	:	703-516-4501

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/21/2022

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