Healthcare Provider Details

I. General information

NPI: 1841194867
Provider Name (Legal Business Name): MICHAEL GENTILE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ANSLOW DR
LELAND NC
28451-9654
US

IV. Provider business mailing address

3695 ANSLOW DR
LELAND NC
28451-9654
US

V. Phone/Fax

Practice location:
  • Phone: 919-308-5405
  • Fax:
Mailing address:
  • Phone: 919-308-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number1235
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: