Basic Information
| Provider Information | |||||||||
| NPI: | 1689663882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 WARREN ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175625612 | ||||||||
| FaxNumber: | 6175625415 | ||||||||
| Practice Location | |||||||||
| Address1: | 697 MASSACHUSETTS AVE | ||||||||
| Address2: | |||||||||
| City: | LUNENBURG | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014621323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785824587 | ||||||||
| FaxNumber: | 9785824593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 07/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39323 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | SX1739 | 01 | MA | PTAN 41 | OTHER | 2042355 | 05 | MA | MEDICAID | SX1726 | 01 | MA | PTAN | OTHER |