MEDICARE: GBGASTRO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1033693023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBGASTRO LLC

Provider Business Mailing Address
First Line	:	475 FRANKLIN ST STE 110
Second Line	:
City	:	FRAMINGHAM
State	:	MA
Zip	:	01702-6265
Country	:	US
Telephone Number	:	508-620-9200
Fax Number	:	508-620-6483

Provider Business Practice Location Address
First Line	:	475 FRANKLIN ST STE 110
Second Line	:
City	:	FRAMINGHAM
State	:	MA
Zip	:	01702-6265
Country	:	US
Telephone Number	:	508-620-9200
Fax Number	:	508-620-6483

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN NEIL FINE
Credential	:	MD
Telephone Number	:	508-620-9200

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/17/2018

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Directions to “GBGASTRO LLC ” Practice Location

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