Basic Information
| Provider Information | |||||||||
| NPI: | 1598768970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YORK | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 357 DOLLY RD | ||||||||
| Address2: | |||||||||
| City: | HOPKINTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032292521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032245220 | ||||||||
| FaxNumber: | 6032243336 | ||||||||
| Practice Location | |||||||||
| Address1: | 194 PLEASANT ST | ||||||||
| Address2: | STE 5 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032245220 | ||||||||
| FaxNumber: | 6032243336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 8086 | NH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 22019661 | 01 | NH | MEDICARE TRAVELERS | OTHER | 0108070Y0NH01 | 01 | NH | BLUECROSS/BLUE SHIELD | OTHER | 80000156N | 05 | NH | MEDICAID |