Provider Demographics
NPI:1093797599
Name:KASSELS, GERALD I (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:I
Last Name:KASSELS
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 1:19 RANSOM RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1106
Mailing Address - Country:US
Mailing Address - Phone:617-332-1644
Mailing Address - Fax:
Practice Address - Street 1:125 NASHUA ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1101
Practice Address - Country:US
Practice Address - Phone:616-573-7110
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2049732Medicaid
MA2049732Medicaid
D83036Medicare UPIN