Healthcare Provider Details

I. General information

NPI: 1912173527
Provider Name (Legal Business Name): MARK ANTHONY GENTILE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ARBOR DR STE H
CHRISTIANSBURG VA
24073-6688
US

IV. Provider business mailing address

360 ARBOR DR STE H
CHRISTIANSBURG VA
24073-6688
US

V. Phone/Fax

Practice location:
  • Phone: 540-381-8700
  • Fax: 540-381-8700
Mailing address:
  • Phone: 540-381-8700
  • Fax: 540-381-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number0104002024
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: