| Richard L Gough, MD | |
|
19 W Frederick St, Walkersville, MD 21793-8230 | |
| (301) 845-6336 | |
| (240) 578-4478 |
| Full Name | Richard L Gough |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 43 Years |
| Location | 19 W Frederick St, Walkersville, Maryland |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346223955 | NPI | - | NPPES |
| 926580505 | Medicaid | MD | |
| 926580506 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D0032171 (Maryland) | Primary |
| 207QG0300X | Family Medicine - Geriatric Medicine | D0032171 (Maryland) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Frederick Health Hospital, Inc | Frederick, MD | Home health agency |
| Amedisys Home Health | Westminster, MD | Home health agency |
| Frederick Health Hospital | Frederick, MD | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Privia Care Center Llc | 3274801139 | 251 |
| Entity Name | Frederick Primary Care Associates, P.a. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689658890 PECOS PAC ID: 9436045648 Enrollment ID: O20040225000299 |
| Entity Name | Privia Medical Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013042480 PECOS PAC ID: 4385682061 Enrollment ID: O20140522000040 |
| Entity Name | Privia Care Center Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1164874426 PECOS PAC ID: 3274801139 Enrollment ID: O20170619000055 |
| Mailing Address | Practice Location Address |
|---|---|
| Richard L Gough, MD 610 Solarex Ct, Frederick, MD 21703-8624 Ph: () - | Richard L Gough, MD 19 W Frederick St, Walkersville, MD 21793-8230 Ph: (301) 845-6336 |
Virginia C Wiley, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 19 W Frederick St, Walkersville, MD 21793 Phone: 301-845-6336 Fax: 240-578-4478 | |
Dr. Andrew Zarick Jr., MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 9502 Highlander Cir, Walkersville, MD 21793 Phone: 484-554-0580 | |
John A Shutta, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 15 E Frederick St, Walkersville, MD 21793 Phone: 301-898-5200 Fax: 301-898-5230 |