Provider Demographics
NPI:1669452942
Name:GONZALEZ, ERIC H (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:GONZALEZ
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 1:1648 HUNTINGDON PIKE
Mailing Address - Street 2:1ST FLOOR BUSINESS OFFICE
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8001
Mailing Address - Country:US
Mailing Address - Phone:215-938-2100
Mailing Address - Fax:215-938-2042
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-938-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032351E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001096875Medicaid
PA0115564000OtherAMERIHEALTH/INTERCOUNTY
PA1079940OtherKEYSTONE MERCY
PA0109687502OtherAMERICHOICE
PA510649OtherPHCS
PAMD032351EOtherHEALTH PARTNERS
PA930072215OtherRR MEDICARE
PA0115564000OtherIBC - PC, KHPE
PA1990089OtherCIGNA HMO/PPO
PA538771OtherHIGHMARK BLUE SHIELD
PA1990089OtherCIGNA HMO/PPO
PAMD032351EOtherHEALTH PARTNERS