Provider Demographics
NPI:1528012283
Name:GOMES, JOAO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAO
Middle Name:ANTONIO
Last Name:GOMES
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 1:3021 PINE TRAILS CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1598
Mailing Address - Country:US
Mailing Address - Phone:330-715-7418
Mailing Address - Fax:
Practice Address - Street 1:3021 PINE TRAILS CIR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1598
Practice Address - Country:US
Practice Address - Phone:330-715-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0957472084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH61801Medicare UPIN
CT001429829Medicaid
CT130000633Medicare ID - Type Unspecified