Provider Demographics
NPI:1891720074
Name:GONZALES, PATRICIA D (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GONZALES
Suffix:
Gender:F
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 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-545-6870
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:505 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2618
Practice Address - Country:US
Practice Address - Phone:804-458-1430
Practice Address - Fax:804-458-8857
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026123208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006700883Medicaid