Provider Demographics
NPI:1801893433
Name:GAYLE, CAROLYN A (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:GAYLE
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:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44999208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
70067OtherHARVARD PILGRIM POS
733890OtherTUFTS
733890OtherTUFTS COMMONWEALTH PPO
J10294OtherMEDICARE
0119539OtherMASS HEALTH
27407OtherCHILDREN'S MEDICAL SEC.
733890OtherTUFTS TOTAL HEALTH PLAN
J10294OtherBS-BLUE CARE ELECT
0016059OtherNEIGHBORHOOD HEALTH PLAN
J10294OtherHMO BLUE/BLUE CHOICE
MA1494141OtherHEALTHSOURCE
70067OtherHARVARD PILGRIM PPO
1494141OtherCIGNA HEALTH CARE
70067OtherHARVARD/PILGRIM
E60222OtherFIRST SENIORITY
12-40536OtherUNITED HEALTHCARE(PPO)
733890OtherTUFTS BENEFIT ADMIN
J10294OtherBLUE SHIELD-INDEMNITY
733890OtherTUFTS