Basic Information
| Provider Information | |||||||||
| NPI: | 1033693023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GBGASTRO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 FRANKLIN ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017026265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086209200 | ||||||||
| FaxNumber: | 5086206483 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 FRANKLIN ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017026265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086209200 | ||||||||
| FaxNumber: | 5086206483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2018 | ||||||||
| LastUpdateDate: | 09/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | FINE | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | NEIL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5086209200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GREATER BOSTON GASTROENTEROLOGY | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.