Individual
JACKELINE GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
23511 HOLLYWOOD RD, SUITE 2, LEONARDTOWN, MD 20650-5833
(301) 997-0611
(301) 997-0709
Mailing address
23511 HOLLYWOOD RD, SUITE 2, LEONARDTOWN, MD 20650-5833
(301) 997-0611
(301) 997-0709
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15661
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992745152
—
ME
05
—
3076395
—
NH
Enumeration date
06/07/2006
Last updated
07/23/2014
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