Provider Demographics
NPI:1588680318
Name:GONZALEZ, ERNESTO R (MD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5545
Mailing Address - Country:US
Mailing Address - Phone:804-320-4243
Mailing Address - Fax:804-622-0552
Practice Address - Street 1:7486 RIGHT FLANK RD STE 100
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3834
Practice Address - Country:US
Practice Address - Phone:804-320-4243
Practice Address - Fax:804-622-0552
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101051054207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7015005OtherMAMSI
VA271532OtherANTHEM PROVIDER NUMBER
VA4800711OtherUNITED HEALTHCARE
VA006032265Medicaid
VA271532OtherANTHEM HEALTHKEEPERS
VA71865OtherSOUTHERN HEALTH
VA006895400OtherBLACK LUNG PROVIDER NUMBE
VA021787OtherCIGNA PROVIDER NUMBER
VA11795OtherCARENET PROVIDER NUMBER
VA557515OtherAETNA NON HMO
VA290008474OtherMEDICARE RAILROAD
VA71865OtherSOUTHERN HEALTH
VAG03591Medicare UPIN