Provider Demographics
NPI:1700916152
Name:GOMAR, ALFONSO ANGEL (MD)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:ANGEL
Last Name:GOMAR
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:PO BOX 6725
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-0725
Mailing Address - Country:US
Mailing Address - Phone:888-808-6483
Mailing Address - Fax:410-721-2656
Practice Address - Street 1:2114 GENERALS HWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7488
Practice Address - Country:US
Practice Address - Phone:888-808-6483
Practice Address - Fax:410-721-2656
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAM D036246L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007152350002Medicaid
PA0007152350002Medicaid
PA0007152350002Medicaid
PAG0037474F5FMedicare PIN