Provider Demographics
NPI:1275618316
Name:GENTILE, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:GENTILE
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 1:821 KENTWOOD DR STE C
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5061
Mailing Address - Country:US
Mailing Address - Phone:330-758-2001
Mailing Address - Fax:330-726-3577
Practice Address - Street 1:821 KENTWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5061
Practice Address - Country:US
Practice Address - Phone:330-758-2001
Practice Address - Fax:330-726-3577
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048093G207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0666837Medicaid
OH0666837Medicaid
OH9927021Medicare ID - Type Unspecified