Provider Demographics
NPI:1154658078
Name:GENTILE, DONALD JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:GENTILE
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:PO BOX 6069
Mailing Address - Street 2:DEPT 87
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:866-282-7905
Mailing Address - Fax:800-731-0751
Practice Address - Street 1:2605 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1476
Practice Address - Country:US
Practice Address - Phone:317-614-9817
Practice Address - Fax:317-614-9655
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028957A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100072060Medicaid
IN100072060Medicaid