Healthcare Provider Details

I. General information

NPI: 1245289453
Provider Name (Legal Business Name): BRENELLY LOZADA-CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENELLY LOZADA MD

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEROY ST
POTSDAM NY
13676-1786
US

IV. Provider business mailing address

2575 NORTHWINDS PKWY
ALPHARETTA GA
30009-2232
US

V. Phone/Fax

Practice location:
  • Phone: 315-261-5890
  • Fax: 315-261-5899
Mailing address:
  • Phone: 678-501-2695
  • Fax: 678-495-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberTP577
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number314595
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: