Provider Demographics
NPI:1831235456
Name:GOES, FERNANDO SAMPAIO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:SAMPAIO
Last Name:GOES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3900 N CHARLES ST
Mailing Address - Street 2:APT 1113
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1756
Mailing Address - Country:US
Mailing Address - Phone:410-889-5999
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:MEYER 4-119D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:443-287-6382
Practice Address - Fax:410-502-0065
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD617122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018330000Medicaid