Provider Demographics
NPI:1275575862
Name:FANCIULLO, GILBERT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:JOSEPH
Last Name:FANCIULLO
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC SECTION OF PAIN MEDICINE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-6040
Mailing Address - Fax:603-650-8199
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC SECTION OF PAIN MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-6040
Practice Address - Fax:603-650-8199
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9961207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010239Medicaid
VT0RE4393Medicaid
NHVN286603Medicare PIN
E79868Medicare UPIN
VTVN2866Medicare PIN