Provider Demographics
NPI:1801853726
Name:GENTILE, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GENTILE
Suffix:
Gender:F
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:P O BOX 1144
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45401
Mailing Address - Country:US
Mailing Address - Phone:937-259-9900
Mailing Address - Fax:937-259-9999
Practice Address - Street 1:627 EDWIN C MOSES BLVD
Practice Address - Street 2:EAST MEDICAL PLAZA
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408
Practice Address - Country:US
Practice Address - Phone:937-223-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350732162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H00281Medicare UPIN
0886493Medicare PIN