Provider Demographics
NPI:1962445940
Name:GONZALEZ, ABEL A (MD)
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:A
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 1:2299 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8908
Mailing Address - Country:US
Mailing Address - Phone:610-882-2052
Mailing Address - Fax:610-882-2054
Practice Address - Street 1:2299 BRODHEAD RD
Practice Address - Street 2:SUITE N
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8908
Practice Address - Country:US
Practice Address - Phone:610-882-2052
Practice Address - Fax:610-882-2054
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041390E103T00000X, 103TP0016X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01950901OtherCAPITAL BLUE CROSS
PA0011766350001Medicaid
PA596171OtherHIGHMARK BLUE SHIELD
PAP853356OtherOXFORD HEALTH PLAN
PAE45226Medicare UPIN
PAP853356OtherOXFORD HEALTH PLAN