Provider Demographics
NPI:1265509277
Name:CRUZ, GELSIMO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GELSIMO
Middle Name:A
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5707
Mailing Address - Country:US
Mailing Address - Phone:410-279-3550
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:21061-5707
Practice Address - Country:US
Practice Address - Phone:410-279-3550
Practice Address - Fax:410-768-2701
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018126207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD186161100Medicaid
MD186161100Medicaid
D74590Medicare UPIN