Provider Demographics
NPI:1073677480
Name:GABOY, NARCISO CUSEODIO (MD)
Entity Type:Individual
Prefix:
First Name:NARCISO
Middle Name:CUSEODIO
Last Name:GABOY
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 1:1312 CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3142
Mailing Address - Country:US
Mailing Address - Phone:615-316-0940
Mailing Address - Fax:615-316-0941
Practice Address - Street 1:1312 CENTRAL CT
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3142
Practice Address - Country:US
Practice Address - Phone:615-316-0940
Practice Address - Fax:615-316-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN131589MD2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000681Medicaid
TN3000681Medicaid
TN3000681Medicare ID - Type Unspecified