Healthcare Provider Details

I. General information

NPI: 1568696326
Provider Name (Legal Business Name): GABRIEL CIVIELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 FRANKLIN HEALTH COMMONS
FARMINGTON ME
04938
US

IV. Provider business mailing address

111 FRANKLIN HEALTH CMNS
FARMINGTON ME
04938-6144
US

V. Phone/Fax

Practice location:
  • Phone: 207-778-0482
  • Fax: 207-778-0133
Mailing address:
  • Phone: 207-778-0482
  • Fax: 207-778-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD19172
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: