Provider Demographics
NPI:1447243563
Name:BENTLEY, DOUGLAS GARY (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GARY
Last Name:BENTLEY
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 1:24 GUILD ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3425
Mailing Address - Country:US
Mailing Address - Phone:781-762-4330
Mailing Address - Fax:781-762-0140
Practice Address - Street 1:24 GUILD ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3425
Practice Address - Country:US
Practice Address - Phone:781-762-4330
Practice Address - Fax:781-762-0140
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-08-19
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-14
Provider Licenses
StateLicense IDTaxonomies
MA48739207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery