MEDICARE: GAZEL INDUSTRIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	010203	MA

General Provider Information

NPI Number	:	1891019006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAZEL INDUSTRIES, INC.

Provider Business Mailing Address
First Line	:	36 KIMBALL BEACH RD
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-1146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 KIMBALL BEACH RD
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-1146
Country	:	US
Telephone Number	:	617-500-4097
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASON BONEY
Credential	:	MD
Telephone Number	:	617-500-4097

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	08/11/2011

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Directions to “GAZEL INDUSTRIES, INC. ” Practice Location

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