Basic Information
| Provider Information | |||||||||
| NPI: | 1427056381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOMEZ FITZPATRICK | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | MAUREEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3046 | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193550746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566324000 | ||||||||
| FaxNumber: | 9569614286 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W EXPRESSWAY 83 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785033045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566324000 | ||||||||
| FaxNumber: | 9569614286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | G1822 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | G1822 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0984163-05 | 05 | TX | MEDICAID | 0984163-06 | 01 | TX | MEDICIAID CSHCN | OTHER |