=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013951011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT GABRIELLI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 04/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 PLEASANT ST
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-7539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-485-8441
-----------------------------------------------------
Fax | 603-485-7718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 PEMBROKE ST
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03275-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-485-8441
-----------------------------------------------------
Fax | 603-485-7718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 6204
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------