Provider Demographics
NPI:1114639242
Name:GONCALVES, FABRICIO GUIMARAES (MD)
Entity Type:Individual
Prefix:DR
First Name:FABRICIO
Middle Name:GUIMARAES
Last Name:GONCALVES
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 1:200 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2240
Mailing Address - Country:US
Mailing Address - Phone:267-872-0737
Mailing Address - Fax:
Practice Address - Street 1:200 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2240
Practice Address - Country:US
Practice Address - Phone:267-872-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4785442085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology