Provider Demographics
NPI:1760648984
Name:LADISA-GONZALEZ, PATRICIA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIA
Last Name:LADISA-GONZALEZ
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 1:1604 SPRING HILL ROAD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-270-4300
Mailing Address - Fax:
Practice Address - Street 1:1604 SPRING HILL RD
Practice Address - Street 2:SUITE 450
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7510
Practice Address - Country:US
Practice Address - Phone:703-270-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine