Provider Demographics
NPI:1114982857
Name:GONZALEZ, MARIA TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TERESA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5322
Mailing Address - Country:US
Mailing Address - Phone:401-277-9992
Mailing Address - Fax:401-270-9620
Practice Address - Street 1:663 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5322
Practice Address - Country:US
Practice Address - Phone:401-277-9992
Practice Address - Fax:401-270-9620
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD092162084P0800X
PAMD057528L2084P0800X
FLME00778152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1021140OtherNHP
19658669OtherMAGELLAN
234261OtherB CROSS
RI9023426Medicaid
402107OtherB CHIP
1562134OtherUNITED HEALTH
1562134OtherUNITED HEALTH