Provider Demographics
NPI:1740493055
Name:GARCIA GONZALEZ, MARIA LOURDES (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LOURDES
Last Name:GARCIA GONZALEZ
Suffix:
Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:1464 MOUNT PLEASANT RD
Mailing Address - Street 2:UNIT 16 SUITE 309
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4043
Mailing Address - Country:US
Mailing Address - Phone:757-880-8969
Mailing Address - Fax:757-428-0514
Practice Address - Street 1:6315 N CENTER DR STE 230
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4006
Practice Address - Country:US
Practice Address - Phone:757-461-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101241378207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
003144OtherANTHEM
1740493055OtherMEDICAID
CB9359OtherMEDICARE RAILROAD PTAN
54-0881234OtherCIGNA
1740493055OtherANTHEM
CO1526OtherMEDICARE
023529OtherANTHEM BCBS
10036017OtherOPTIMA