Provider Demographics
NPI:1083149066
Name:GOMERA DIPRES, MARCO AMAURY (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:AMAURY
Last Name:GOMERA DIPRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NO. 9 CALLE PRINCIPAL
Mailing Address - Street 2:RESIDENCIAL GALA
Mailing Address - City:SANTO DOMINGO
Mailing Address - State:DISTRITO NACIONAL
Mailing Address - Zip Code:10601
Mailing Address - Country:DO
Mailing Address - Phone:809-540-9079
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program