Provider Demographics
NPI:1326025750
Name:CILENTO, BARTLEY GRAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BARTLEY
Middle Name:GRAY
Last Name:CILENTO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:CHILDRENS UROLOGICAL FOUNDATION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-8338
Mailing Address - Fax:617-730-0474
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CHILDRENS UROLOGICAL FOUNDATION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-8338
Practice Address - Fax:617-730-0474
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA156057208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11273OtherHNE
1900235OtherUNI1
30200111OtherWNH
000000009231OtherBMC
AA8298OtherHPHC
47667OtherFCHP
601850OtherHPHC
1900235OtherUNI4
1900235OtherUNI7
0012992OtherNHP
156057OtherTUFTS
1900235OtherUHP
1900235OtherMETRA
Z11048OtherHEALT
P1698214OtherOXFORD
MA3176801Medicaid
7007980004OtherCIG2
994862OtherNETHE
MA3176801Medicaid