Healthcare Provider Details

I. General information

NPI: 1851379630
Provider Name (Legal Business Name): DEBRA SUSAN GERSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTH ST FAMILY PRACTICE ASSOCIATES
MEDFIELD MA
02052-1654
US

IV. Provider business mailing address

1569 BEACON ST APT 31
BROOKLINE MA
02446-4612
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-1519
  • Fax: 508-359-4345
Mailing address:
  • Phone: 617-277-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number216260
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: