Healthcare Provider Details

I. General information

NPI: 1962445940
Provider Name (Legal Business Name): ABEL A GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 BRODHEAD RD SUITE N
BETHLEHEM PA
18020-8908
US

IV. Provider business mailing address

2299 BRODHEAD RD
BETHLEHEM PA
18020-8908
US

V. Phone/Fax

Practice location:
  • Phone: 610-882-2052
  • Fax: 610-882-2054
Mailing address:
  • Phone: 610-882-2052
  • Fax: 610-882-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMD041390E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMD041390E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD041390E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: