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General NPI Number Information
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NPI Number | 1487185344
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Entity Type | Individual
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Provider Name | OLIVER GENTILE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 04/03/2022
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Provider Practice Location Address
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Address Line | 633D MEDICAL GROUP 77 NEALY AVENUE
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City | JOINT BASE LANGLEY-EUSTIS
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone | 757-764-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 276 11TH ST
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City | BROOKLYN
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State | NY
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Zip | 11215-3911
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Country | US
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Telephone | 646-469-3949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 297859
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101272988
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License Number State | VA
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