Individual
ANGELES GONZALEZ-PRADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
602 E 21ST ST, SUITE 400, NORTHAMPTON, PA 18067-1259
(610) 262-1519
(610) 262-7125
Mailing address
315 NEW ST, PHILADELPHIA, PA 19106-1132
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD062524L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016576820003
—
PA
01
—
0514959000
IBC
—
01
—
260592
HIGHMARK BLUE SHIELD
—
01
—
50055254
CBC
—
01
—
P002678
GATEWAY
—
Enumeration date
10/21/2005
Last updated
08/02/2023
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