Healthcare Provider Details

I. General information

NPI: 1841388436
Provider Name (Legal Business Name): GONZALO H VERDUGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ENDICOTT ST SUITE 100
DANVERS MA
01923-3623
US

IV. Provider business mailing address

104 ENDICOTT ST SUITE 100
DANVERS MA
01923-3623
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-6601
  • Fax:
Mailing address:
  • Phone: 978-745-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA68261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: