Provider Demographics
NPI:1295791176
Name:NOGUERA, EDUARDO CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:CHRISTIAN
Last Name:NOGUERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 COMMERCE PARK DR
Mailing Address - Street 2:LL4
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1555
Mailing Address - Country:US
Mailing Address - Phone:703-766-2650
Mailing Address - Fax:703-766-2654
Practice Address - Street 1:11440 COMMERCE PARK DR
Practice Address - Street 2:LL4
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1555
Practice Address - Country:US
Practice Address - Phone:703-766-2650
Practice Address - Fax:703-766-2654
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231137207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010130301Medicaid
I23668Medicare UPIN
010155W30Medicare PIN