Provider Demographics
NPI:1124020730
Name:THATCHER, GENTRY W (MD)
Entity Type:Individual
Prefix:
First Name:GENTRY
Middle Name:W
Last Name:THATCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:198 MASSACHUSETTS AVE #103
Mailing Address - Street 2:
Mailing Address - City:N ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-685-7550
Mailing Address - Fax:978-686-5565
Practice Address - Street 1:198 MASSACHUSETTS AVE #103
Practice Address - Street 2:
Practice Address - City:N ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-685-7550
Practice Address - Fax:978-686-5565
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204712207Y00000X
NH11012207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2344337OtherAETNA/USHC
B20973001OtherCIGNA
0020548OtherNHP
01Y002475MA01OtherNH BS
204712OtherSECURE HORIZ
7439118-001OtherCIGNA PAL
76754OtherAAO/HNS
976854OtherNETWORK HEALTH
J22387OtherBS-HMO
10-00243OtherUNITED HC
J22387OtherBS/MA
MA0104914Medicaid
19901OtherH/PIL
65475OtherFALLON
040015652OtherMC RR
204712OtherTUFTS
204712OtherTUFTS
A31113Medicare ID - Type Unspecified
MA0104914Medicaid