Provider Demographics
NPI:1700129236
Name:AVELLINO, GABRIELLA JULIET (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:JULIET
Last Name:AVELLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E NEWTON ST # C515
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-4882
Mailing Address - Fax:
Practice Address - Street 1:2 DUDLEY ST STE 175
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3246
Practice Address - Country:US
Practice Address - Phone:401-421-0710
Practice Address - Fax:401-421-0796
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16351208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program