Provider Demographics
NPI:1972861607
Name:BELOSEVIC, GABRIEL (NP, RN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BELOSEVIC
Suffix:
Gender:M
Credentials:NP, RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4302
Mailing Address - Country:US
Mailing Address - Phone:617-927-6099
Mailing Address - Fax:
Practice Address - Street 1:254 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494-2829
Practice Address - Country:US
Practice Address - Phone:617-421-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN227279207RG0300X
MARN2277279163W00000X, 363LA2200X, 363LP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health