Provider Demographics
NPI:1477700227
Name:GONZALEZ, NELIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:NELIDA
Middle Name:
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 1:700 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:#815
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2407
Mailing Address - Country:US
Mailing Address - Phone:202-333-6853
Mailing Address - Fax:
Practice Address - Street 1:700 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:#815
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2407
Practice Address - Country:US
Practice Address - Phone:202-333-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD6067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC89027Medicare UPIN