Provider Demographics
NPI:1245294610
Name:GONZALEZ, CARMEN LAURA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LAURA
Last Name: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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-245-7190
Mailing Address - Fax:
Practice Address - Street 1:78 MEDICAL CENTER DRIVE
Practice Address - Street 2:HEART & VASCULAR CENTER, FLR 2
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-245-7190
Practice Address - Fax:540-245-7191
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10202207RP1001X
VA0101039166207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C73391Medicare UPIN
NC2281169Medicare ID - Type UnspecifiedMEDICARE
NC41344OtherPARTNERS MEDICARE
NCA0167OtherMEDCOST
C73391Medicare UPIN
NC2281169Medicare ID - Type UnspecifiedMEDICARE
NC89127P8Medicaid