Healthcare Provider Details

I. General information

NPI: 1689779969
Provider Name (Legal Business Name): ELENA K GONZALEZ-ABREU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELENA NORCH MD

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 EDGEBROOK RD NE
BOLIVAR OH
44612-8706
US

IV. Provider business mailing address

3579 VINEYARD AVE NW
CANTON OH
44708-5884
US

V. Phone/Fax

Practice location:
  • Phone: 330-874-3545
  • Fax:
Mailing address:
  • Phone: 330-354-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35080756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: