Provider Demographics
NPI:1427010800
Name:GOMEZ AGUINAGA, MIGUEL A (MD)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:GOMEZ AGUINAGA
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:78 MEDICAL CENTER DRIVE
Practice Address - Street 2:HEART & VASCULAR CENTER, 2ND FLOOR
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-245-7380
Practice Address - Fax:540-245-7381
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE17912086S0129X
VA0101263076208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143801001Medicaid
AR5L853Medicare ID - Type Unspecified
AR143801001Medicaid