Healthcare Provider Details

I. General information

NPI: 1699160804
Provider Name (Legal Business Name): GABRIELLE ELISE DOMBEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLE ELISE CERVONI MD

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST STE 407
CAMBRIDGE MA
02138-5665
US

IV. Provider business mailing address

330 MOUNT AUBURN ST # 2
CAMBRIDGE MA
02138-5597
US

V. Phone/Fax

Practice location:
  • Phone: 617-868-7456
  • Fax:
Mailing address:
  • Phone: 617-402-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number274853
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number274853
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: