MEDICARE: DR. GABRYEL OBEDOZA MD

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	207Q00000X	Family Medicine Physician	1026895	MA

General Provider Information

NPI Number	:	1588367320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRYEL OBEDOZA MD

Provider Business Mailing Address
First Line	:	25 BOYLSTON ST STE 204
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-1710
Country	:	US
Telephone Number	:	617-546-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 BOYLSTON ST STE 204
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-1710
Country	:	US
Telephone Number	:	617-546-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	06/08/2026

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