Provider Demographics
NPI:1457842411
Name:GENTILE, EARL THOMAS
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:THOMAS
Last Name:GENTILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20455 LORAIN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3529
Mailing Address - Country:US
Mailing Address - Phone:440-333-3271
Mailing Address - Fax:440-333-3272
Practice Address - Street 1:20455 LORAIN RD STE 105
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3529
Practice Address - Country:US
Practice Address - Phone:440-333-3271
Practice Address - Fax:440-333-3272
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.02462237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2980065Medicaid