Provider Demographics
NPI:1689665085
Name:CILENTO, BARTLEY GRAY SR (MD)
Entity Type:Individual
Prefix:
First Name:BARTLEY
Middle Name:GRAY
Last Name:CILENTO
Suffix:SR
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:GREENBUSH
Mailing Address - State:MA
Mailing Address - Zip Code:02040-0217
Mailing Address - Country:US
Mailing Address - Phone:781-545-3391
Mailing Address - Fax:781-545-7270
Practice Address - Street 1:7 NEW DRIFTWAY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4534
Practice Address - Country:US
Practice Address - Phone:781-545-3391
Practice Address - Fax:781-545-7270
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0115584Medicaid
703705OtherTUFTS
MA20154OtherHPHC
1200542OtherUNITED
MACIJ08010OtherBCBS
MACIJ08010OtherBCBS
D88521Medicare UPIN