Provider Demographics
NPI:1740324730
Name:ROHALD, GIL (MD)
Entity type:Individual
Prefix:DR
First Name:GIL
Middle Name:
Last Name:ROHALD
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 1:130 UPTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3221
Mailing Address - Country:US
Mailing Address - Phone:508-366-5868
Mailing Address - Fax:508-366-5868
Practice Address - Street 1:340 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1509
Practice Address - Country:US
Practice Address - Phone:508-943-2600
Practice Address - Fax:508-764-2448
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA59910207PE0004X
MA59910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
E59613Medicare UPIN
J10225Medicare ID - Type Unspecified