Provider Demographics
NPI:1841574597
Name:GONZALEZ, MIGUEL H
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:H
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44112 RIVERPOINT DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8206
Mailing Address - Country:US
Mailing Address - Phone:703-201-9547
Mailing Address - Fax:
Practice Address - Street 1:44112 RIVERPOINT DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8206
Practice Address - Country:US
Practice Address - Phone:703-201-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020252208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC48600001OtherBC/BS NATIONAL CAPITAL AREA
VAC88663Medicare UPIN
DC48600001OtherBC/BS NATIONAL CAPITAL AREA