Provider Demographics
NPI:1407980717
Name:GOMEZ YIM & RASTOGI, M.D., P.A.
Entity Type:Organization
Organization Name:GOMEZ YIM & RASTOGI, M.D., P.A.
Other - Org Name:BEL AIR PEDIATRIC CENTER HAVRE DE GRACE PEDIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:YIM
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:410-838-9555
Mailing Address - Street 1:602 S. ATWOOD ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-838-9555
Mailing Address - Fax:410-836-5056
Practice Address - Street 1:602 S. ATWOOD ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-838-9555
Practice Address - Fax:410-836-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD226381500Medicaid