1730186818 NPI number — DAVID S GENDELMAN MD

Table of content: DAVID S GENDELMAN MD (NPI 1730186818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730186818 NPI number — DAVID S GENDELMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENDELMAN
Provider First Name:
DAVID
Provider Middle Name:
S
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:
1730186818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 CAMBRIDGE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-202-2020
Provider Business Mailing Address Fax Number:
617-734-3264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 WEBSTER PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02445-7937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-272-4944
Provider Business Practice Location Address Fax Number:
781-272-8756
Provider Enumeration Date:
07/05/2005

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:  55101 , 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: 043070848015 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 108 . This is a "SECURE HORIZONS NEEC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3001067 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8180 . This is a "CIGNA HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "REGENCE BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 991743 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BCBS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BCBS OF PENNSYLVANIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15316 . This is a "HARVARD COMM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BCBS OF CONNECTICUT" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BCBS OF MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0800236 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BCBS OF OREGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BCBC OF ILLINOIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CE5062 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "HORIZON BCBS OF NJ" identifier . This identifiers is of the category "OTHER".
  • Identifier: GEJ04746 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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