Provider Demographics
NPI:1053849976
Name:TOLENTINO, GERARDO ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:ELIAS
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4877
Mailing Address - Country:US
Mailing Address - Phone:203-372-4065
Mailing Address - Fax:203-372-1644
Practice Address - Street 1:112 QUARRY RD STE 120
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4877
Practice Address - Country:US
Practice Address - Phone:203-372-4065
Practice Address - Fax:203-372-1644
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine