Healthcare Provider Details

I. General information

NPI: 1437182607
Provider Name (Legal Business Name): GINTER SOTREL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 MILK ST OB / GYN
BOSTON MA
02109-4862
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT ,9TH FLOOR
BOSTON MA
02109-4862
US

V. Phone/Fax

Practice location:
  • Phone: 617-654-7280
  • Fax: 617-654-7363
Mailing address:
  • Phone: 617-421-6540
  • Fax: 617-421-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number38193
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number38193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: