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General NPI Number Information
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NPI Number | 1174738942
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Entity Type | Organization
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Legal Business Name | DONALD J GENTILE MD PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 SOUTH ST STE 208 MEDICAL ARTS BUILDING
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-4051
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Country | US
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Telephone | 508-764-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SOUTH ST STE 208 MEDICAL ARTS BUILDING
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-4051
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Country | US
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Telephone | 508-764-6356
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD JOSEPH GENTILE
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Credential | MD
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Telephone | 508-764-6356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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