Provider Demographics
NPI:1598870685
Name:GOMUWKA, PATRICIA KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KATHERINE
Last Name:GOMUWKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12695 MCMANUS BLVD
Mailing Address - Street 2:BLDG 7 SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4435
Mailing Address - Country:US
Mailing Address - Phone:757-872-8597
Mailing Address - Fax:757-872-0650
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:BLDG 7 SUITE A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-872-8597
Practice Address - Fax:757-872-0650
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035916208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007169OtherANTHEM
VA52154OtherOPTIMA
B07560Medicare UPIN