Healthcare Provider Details

I. General information

NPI: 1033478631
Provider Name (Legal Business Name): GELSIMO A. CRUZ, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL DRIVE SUITE 230
GLEN BURNIE MD
21061-5803
US

IV. Provider business mailing address

300 HOSPITAL DRIVE SUITE 230
GLEN BURNIE MD
21061-5803
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-2700
  • Fax: 410-768-2701
Mailing address:
  • Phone: 410-768-2700
  • Fax: 410-768-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0018126
License Number StateMD

VIII. Authorized Official

Name: MR. GELSIMO ANGELES CRUZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-768-2700