Provider Demographics
NPI:1336163419
Name:GENTILE, DOUGLAS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
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 1:467 BEAVER CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FAHC, EMERGENCY DEPARTMENT
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3982
Practice Address - Fax:802-847-5963
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-0009006207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1027Medicaid
NH30200445Medicaid
NYE01526521Medicaid
VTA97972Medicare UPIN
VT0VN1027Medicaid