Healthcare Provider Details

I. General information

NPI: 1609852425
Provider Name (Legal Business Name): ROBERT GENNARO BRANCALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 LIBBEY PKWY SUITE 301
WEYMOUTH MA
02189-3101
US

IV. Provider business mailing address

163 LIBBEY PKWY SUITE 301
WEYMOUTH MA
02189-3101
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-4224
  • Fax: 781-335-0429
Mailing address:
  • Phone: 781-337-4224
  • Fax: 781-335-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number37435
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: