Provider Demographics
NPI:1649217571
Name:GONZALES-VIGILAR, MARIA CARMEN V (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARIA CARMEN
Middle Name:V
Last Name:GONZALES-VIGILAR
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Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:44031 PIPELINE PLZ
Mailing Address - Street 2:STE 205
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5887
Mailing Address - Country:US
Mailing Address - Phone:571-291-2449
Mailing Address - Fax:571-291-3681
Practice Address - Street 1:44031 PIPELINE PLAZA
Practice Address - Street 2:STE 205
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:571-291-2449
Practice Address - Fax:571-291-3681
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010770252084P0804X, 2084P0800X
VA01012405462084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540682401Medicaid