Healthcare Provider Details

I. General information

NPI: 1699201988
Provider Name (Legal Business Name): CRISTIAN DANIEL GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 CARNEGIE ROW STE 202
NORWOOD MA
02062-5162
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3310
US

V. Phone/Fax

Practice location:
  • Phone: 781-762-5858
  • Fax: 781-617-6202
Mailing address:
  • Phone: 978-371-7010
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22375
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA196738
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1028615
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: