Provider Demographics
NPI:1588958615
Name:GOSSWEILER, MARISA RACHEL (DO)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:RACHEL
Last Name:GOSSWEILER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:RACHEL
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 TERRELL RD UNIT 8
Mailing Address - Street 2:
Mailing Address - City:ALAMO HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6329
Mailing Address - Country:US
Mailing Address - Phone:631-767-2370
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:631-767-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9512085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice