Provider Demographics
NPI:1720070261
Name:GOORAY, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GOORAY
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 1:1450 MERCANTILE LN
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5376
Mailing Address - Country:US
Mailing Address - Phone:301-583-7770
Mailing Address - Fax:301-583-9414
Practice Address - Street 1:1450 MERCANTILE LN
Practice Address - Street 2:SUITE 217
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5376
Practice Address - Country:US
Practice Address - Phone:301-583-7770
Practice Address - Fax:301-583-9414
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-04-07
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
MDD0028195207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377631000Medicaid
MD463312Medicare PIN
MDC89166Medicare UPIN