Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | D0063896 | MD |
NPI | 1023115326 |
---|---|
Provider Name | Dr. Denise Renee Gooch |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Greenbelt, MD 20770-3508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 27/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004 | CAREFIRST BCBS (01) | DC |
0009 | CAREFIRST BCBS (01) | DC |
01380038 | AMERIGROUP (01) | MD |
01454904 | AMERIGROUP (OMB) (01) | MD |
057897600 | (05) | DC |
145440YYP | (05) | MD |
3113508 | CIGNA (01) | MD |
31430 | CHARTERED HEALTH PLAN (01) | MD |
409824200 | (05) | MD |
4348867 | AETNA (01) | MD |
4348867 | AETNA - NWB (01) | MD |
61736101 | CAREFIRST BCBS (01) | MD |
881027-01 | CAREFIRST BCBS (01) | MD |
F56077 | (02) | MD |
P00865911 | RAILROAD MEDICARE (01) | MD |