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Individual

DR. MARIO H GOMEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5918 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 353-0010
(804) 353-0041
Mailing address
PO BOX 5567, 5918 HARBOR PARK DRIVE, MIDLOTHIAN, VA 23112-0027
(804) 353-0010
(804) 353-0041

Taxonomy

Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
0101042524
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004945557
VA
05
007172966
VA
01
036579003
MAGELLAN
VA
01
267418
MAMSI
VA
01
381732
ANTHEM - POWH LOC
VA
01
451731
ANTHEM - GCH LOC
VA
01
A932442
VALUE OPTIONS
VA
01
O89172
SENTARA
VA
Enumeration date
06/02/2006
Last updated
05/13/2008
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