MEDICARE: DR. ALFREDO IGNACIO GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	155325	MA
2	2084P0802X	Addiction Psychiatry Physician	155325	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8527758	OTHER	MA	CIGNA
2	1396730123	OTHER	MA	BCBS
3	222703314	OTHER	MA	COVENTRY/FIRST HEALTH
4	1396730123	OTHER	MA	GIC/UNICARE
5	012266	OTHER	MA	SENIOR WHOLE HEALTH
6	1396730123	OTHER	MA	FALLON
7	401530	OTHER	MA	TUFTS
8	7827059	OTHER	MA	AETNA
9	AA144537	OTHER	MA	HPHC

General Provider Information

NPI Number	:	1396730123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO IGNACIO GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	100 N FRONT ST
Second Line	:	3FL
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7350
Country	:	US
Telephone Number	:	508-994-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 BELLEVILLE AVE
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02746-2403
Country	:	US
Telephone Number	:	508-994-0885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	02/15/2017

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