Healthcare Provider Details

I. General information

NPI: 1629565049
Provider Name (Legal Business Name): EDGAR ZAMORA GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

205 S FRONT STREET
HARRISBURG PA
17105
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2000
  • Fax:
Mailing address:
  • Phone: 717-231-8634
  • Fax: 717-231-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1026146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: