Provider Demographics
NPI:1821020280
Name:TRINQUE, GAIL (PA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:TRINQUE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1171
Mailing Address - Country:US
Mailing Address - Phone:781-767-0910
Mailing Address - Fax:781-767-9019
Practice Address - Street 1:175 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1171
Practice Address - Country:US
Practice Address - Phone:781-767-0910
Practice Address - Fax:781-767-9019
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP2018Medicare PIN