Provider Demographics
NPI:1578881991
Name:MACATANGAY GERONILLA, CONSTANCIA FATIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCIA
Middle Name:FATIMA
Last Name:MACATANGAY GERONILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CONSTANCIA FATIMA
Other - Middle Name:
Other - Last Name:MACATANGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2790 GODWIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8151
Mailing Address - Country:US
Mailing Address - Phone:757-983-8750
Mailing Address - Fax:757-510-9442
Practice Address - Street 1:2790 GODWIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8151
Practice Address - Country:US
Practice Address - Phone:757-983-8750
Practice Address - Fax:757-510-9442
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101264253207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program