Provider Demographics
NPI:1356397137
Name:GABRIEL, ALIS G (MD)
Entity type:Individual
Prefix:
First Name:ALIS
Middle Name:G
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5830
Mailing Address - Country:US
Mailing Address - Phone:978-825-6581
Mailing Address - Fax:978-825-7070
Practice Address - Street 1:496 LYNNFIELD ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-1423
Practice Address - Country:US
Practice Address - Phone:781-593-3400
Practice Address - Fax:781-477-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA161365207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0127035Medicaid
MAA32138Medicare ID - Type Unspecified
H33386Medicare UPIN