Provider Demographics
NPI:1033478631
Name:GELSIMO A. CRUZ, M.D. P.A.
Entity Type:Organization
Organization Name:GELSIMO A. CRUZ, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GELSIMO
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-768-2700
Mailing Address - Street 1:300 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5803
Mailing Address - Country:US
Mailing Address - Phone:410-768-2700
Mailing Address - Fax:410-768-2701
Practice Address - Street 1:300 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-768-2700
Practice Address - Fax:410-768-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018126207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty