Manuel Borja Gonzales, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

0101026717 Issued in VA

Practice address

801 S Adams St
Laboratory
Petersburg, VA 23803-5149

Phone

(804) 862-5010

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Petersburg Pathology Associates LTD.

  • Anatomic Pathology & Clinical Pathology Physician
  • Petersburg, VA
  • NPI 1871679704
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194825600000",
    "number": "1447349444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S ADAMS ST",
            "address_2": "LABORATORY",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238035149",
            "telephone_number": "804-862-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S ADAMS ST",
            "address_2": "LABORATORY",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238035149",
            "telephone_number": "804-862-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "MANUEL",
        "middle_name": "BORJA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "VA",
            "license": "0101026717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6680241",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "015388",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gnus Corporation
• Jonathan C Gogol, PMHNP
• Golden Physician Partners, LLC
• Golden Physician Partners, LLC
• Golden Physician Partners, LLC
• Sarah Goolsby, DPT
• Tandrea Graham, MSW
• Tina Stoll Graham, RPH
• Rolette Michelle Grandison
• Kenneth Alonzo Graves, CSAC

• Anatomic Pathology & Clinical Pathology Physician in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.