1528024452 NPI number — ROBERT L GISE MD

Table of content: ROBERT L GISE MD (NPI 1528024452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528024452 NPI number — ROBERT L GISE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GISE
Provider First Name:
ROBERT
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528024452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 LINCOLN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-2529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-755-4922
Provider Business Mailing Address Fax Number:
508-756-9918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 LINCOLN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-755-4922
Provider Business Practice Location Address Fax Number:
508-756-9918
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  39600 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2067269 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0800341 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15527 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 988733 . This is a "NETWORK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 039600 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0880401 . This is a "EVERCARE UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4255 . This is a "FALLON HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: N01801 . This is a "BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4207 . This is a "US HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004670 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4274763 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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