Provider Demographics
NPI:1023115326
Name:GOOCH, DENISE RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:RENEE
Last Name:GOOCH
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7503 GREENWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3508
Practice Address - Country:US
Practice Address - Phone:301-446-3540
Practice Address - Fax:301-446-3543
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063896208D00000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0004OtherCAREFIRST BCBS
MD01380038OtherAMERIGROUP
MD31430OtherCHARTERED HEALTH PLAN
DC0009OtherCAREFIRST BCBS
MD01454904OtherAMERIGROUP (OMB)
DC057897600Medicaid
MD145440YYPMedicaid
MD881027-01OtherCAREFIRST BCBS
MDP00865911OtherRAILROAD MEDICARE
MD409824200Medicaid
MD4348867OtherAETNA - NWB
MD61736101OtherCAREFIRST BCBS
MD3113508OtherCIGNA
MD4348867OtherAETNA
DC057897600Medicaid
MD01380038OtherAMERIGROUP
MD61736101OtherCAREFIRST BCBS
MD3113508OtherCIGNA