Provider Demographics
NPI:1558333658
Name:GONZALEZ, MICHELE JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:JANE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1003
Mailing Address - Country:US
Mailing Address - Phone:757-377-1366
Mailing Address - Fax:
Practice Address - Street 1:ATLANTIC DERMATOLOGY ASSOCIATES
Practice Address - Street 2:1101 FIRST COLONIAL RD., SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2409
Practice Address - Country:US
Practice Address - Phone:757-481-1666
Practice Address - Fax:757-481-7696
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235274207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology