Provider Demographics
NPI:1639100886
Name:YUIL, GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:YUIL
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 1:37 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-3501
Mailing Address - Country:US
Mailing Address - Phone:978-682-3233
Mailing Address - Fax:978-682-7312
Practice Address - Street 1:37 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-3501
Practice Address - Country:US
Practice Address - Phone:978-682-3233
Practice Address - Fax:978-682-7312
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47382208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2077434Medicaid
MA110038849AMedicaid
MAJ0111203Medicare PIN
MAJ01112Medicare ID - Type Unspecified
MAA56220Medicare UPIN