Provider Demographics
NPI:1750699286
Name:GENTILE, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GENTILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ALLENS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5443
Mailing Address - Country:US
Mailing Address - Phone:401-444-3201
Mailing Address - Fax:
Practice Address - Street 1:765 ALLENS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-5443
Practice Address - Country:US
Practice Address - Phone:401-444-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist