Provider Demographics
NPI:1336148618
Name:GAVRILESCU, THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:GAVRILESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:491 MAPLE ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4023
Mailing Address - Country:US
Mailing Address - Phone:978-762-4888
Mailing Address - Fax:978-762-3922
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-687-2587
Practice Address - Fax:978-687-8268
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-03-17
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Provider Licenses
StateLicense IDTaxonomies
MA743562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3100006Medicaid
F50174Medicare UPIN
MAJ13462Medicare ID - Type Unspecified
MAJ13462Medicare PIN