Healthcare Provider Details

I. General information

NPI: 1275723413
Provider Name (Legal Business Name): GEORGE A. GONZALEZ, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 OLD ROAD TO 9 ACRE COR SUITE 660
CONCORD MA
01742-4181
US

IV. Provider business mailing address

131 OLD ROAD TO 9 ACRE COR SUITE 660
CONCORD MA
01742-4181
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-2934
  • Fax: 978-287-2934
Mailing address:
  • Phone: 978-287-2934
  • Fax: 978-287-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number231414
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number231414
License Number StateMA

VIII. Authorized Official

Name: DR. GEORGE ANDREW GONZALEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-773-9386