Healthcare Provider Details

I. General information

NPI: 1982714622
Provider Name (Legal Business Name): DAVID WILLIAM GENTRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

PO BOX 223323
CHANTILLY VA
20153-3323
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-3293
  • Fax:
Mailing address:
  • Phone: 540-349-0595
  • Fax: 540-349-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101052416
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: