Provider Demographics
NPI:1073541926
Name:GENTILE, REID (DO)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:
Last Name:GENTILE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1331
Mailing Address - Country:US
Mailing Address - Phone:814-467-3176
Mailing Address - Fax:814-467-3177
Practice Address - Street 1:600 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1331
Practice Address - Country:US
Practice Address - Phone:814-467-3176
Practice Address - Fax:814-467-3177
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000232207V00000X
PAOS-005206L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101889984 0002Medicaid
CT008021615Medicaid
CTE07645Medicare UPIN
PA101889984 0002Medicaid