Provider Demographics
NPI:1538455837
Name:GOITOM, WINTYE (CRNA)
Entity type:Individual
Prefix:
First Name:WINTYE
Middle Name:
Last Name:GOITOM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GOLDSBORO RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5846
Mailing Address - Country:US
Mailing Address - Phone:301-263-0820
Mailing Address - Fax:301-263-0820
Practice Address - Street 1:6400 GOLDSBORO RD STE 400
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-263-0820
Practice Address - Fax:301-263-0820
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY642863-1367H00000X
MDR185864367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare PIN