Provider Demographics
NPI:1659534493
Name:GONCZ, DOUGLAS DANA (CPS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DANA
Last Name:GONCZ
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4394
Mailing Address - Street 2:
Mailing Address - City:SEVEN CORNERS
Mailing Address - State:VA
Mailing Address - Zip Code:22044-0394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3041 PATRICK HENRY DR 2
Practice Address - Street 2:THE 4 BUTTON IS STICKY
Practice Address - City:SEVEN CORNERS
Practice Address - State:VA
Practice Address - Zip Code:22044-2536
Practice Address - Country:US
Practice Address - Phone:937-315-2684
Practice Address - Fax:571-395-3575
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker