Healthcare Provider Details

I. General information

NPI: 1700528338
Provider Name (Legal Business Name): COREY GATEWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6106
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115-6106
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-7921
  • Fax:
Mailing address:
  • Phone: 617-525-7921
  • Fax: 404-756-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number1026367
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: