Healthcare Provider Details

I. General information

NPI: 1396730123
Provider Name (Legal Business Name): ALFREDO IGNACIO GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 BELLEVILLE AVE
NEW BEDFORD MA
02746-2403
US

IV. Provider business mailing address

100 N FRONT ST 3FL
NEW BEDFORD MA
02740-7350
US

V. Phone/Fax

Practice location:
  • Phone: 508-994-0885
  • Fax:
Mailing address:
  • Phone: 508-994-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number155325
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number155325
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: