Basic Information
| Provider Information | |||||||||
| NPI: | 1841388436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERDUGO | ||||||||
| FirstName: | GONZALO | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 ENDICOTT ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019233623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787456601 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 104 ENDICOTT ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019233623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787456601 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | A68261 | CA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.