Healthcare Provider Details

I. General information

NPI: 1205913373
Provider Name (Legal Business Name): EDUARDO J GONZALEZ-VELEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64264
BALTIMORE MD
21264-4264
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5780
  • Fax: 410-328-8315
Mailing address:
  • Phone: 410-550-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD71200
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD71200
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: