Provider Demographics
NPI:1144458217
Name:SIMO, DAGOBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DAGOBERT
Middle Name:
Last Name:SIMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 HONEY LOCUST CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6016
Mailing Address - Country:US
Mailing Address - Phone:410-487-6902
Mailing Address - Fax:
Practice Address - Street 1:1403 MADISON PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6189
Practice Address - Country:US
Practice Address - Phone:410-487-6902
Practice Address - Fax:410-487-6982
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073466207QA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine