Provider Demographics
NPI:1528051919
Name:GOICOCHEA, JUVENAL RODOLFO (MD)
Entity type:Individual
Prefix:
First Name:JUVENAL
Middle Name:RODOLFO
Last Name:GOICOCHEA
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 59350
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-9350
Mailing Address - Country:US
Mailing Address - Phone:301-657-9445
Mailing Address - Fax:301-718-8626
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-657-9445
Practice Address - Fax:301-718-8626
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD002450208600000X
DCMD12034208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
35460001OtherCAREFIRST DC
3787OtherCAREFIRST MD
29260OtherMDM 61
29260OtherMDM 61
046504Medicare ID - Type Unspecified