Basic Information
| Provider Information | |||||||||
| NPI: | 1205839784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAYRE | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SAWYER | ||||||||
| OtherFirstName: | GAIL | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 24 MORRILL PL | ||||||||
| Address2: | |||||||||
| City: | AMESBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019133530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788348074 | ||||||||
| FaxNumber: | 9788348077 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019503867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784631383 | ||||||||
| FaxNumber: | 9784631386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 10/29/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 9687 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010122729 | 01 | NH | RAILROAD MEDICARE ID# | OTHER | 0106222YPNH01 | 01 | NH | ANTHEM ID# | OTHER | G33728 | 01 | NH | HARVARD PILGRIM ID # | OTHER | 222594672 | 01 | NH | GREATWEST HEALTHCARE ID# | OTHER | 2139311 | 01 | NH | CIGNA ID # | OTHER | 222594672 | 01 | NH | PRIVATE HEALTH CARE ID# | OTHER | 3009542 | 05 | NH | MEDICAID | 371551 | 01 | NH | MVP HEALTHCARE ID# | OTHER | 0106222Y0NH01 | 01 | NH | ANTHEM HFH ID# | OTHER | 222594672 | 01 | NH | HEALTH CARE VALUE MANAG# | OTHER | 3016256 | 01 | NH | AETNA ID# | OTHER | H005016 | 01 | NH | TRICARE ID# | OTHER | 01-04592 | 01 | NH | UNITED HEALTHCARE ID# | OTHER | 371552 | 01 | NH | MVP HEALTHCARE HFH ID# | OTHER |