Healthcare Provider Details

I. General information

NPI: 1780673970
Provider Name (Legal Business Name): WAYNE A GAVRYCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BURNHAM ST
TURNERS FALLS MA
01376-1816
US

IV. Provider business mailing address

8 BURNHAM ST
TURNERS FALLS MA
01376-1816
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-5554
  • Fax: 413-775-9137
Mailing address:
  • Phone: 413-774-5554
  • Fax: 413-775-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMA47621
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: