Provider Demographics
NPI:1952419616
Name:BROVAR, GILBERT T (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:T
Last Name:BROVAR
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 1:15818 RIVERSIDE DR W APT 6K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1064
Mailing Address - Country:US
Mailing Address - Phone:508-259-6078
Mailing Address - Fax:
Practice Address - Street 1:15818 RIVERSIDE DR W APT 6K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1064
Practice Address - Country:US
Practice Address - Phone:508-259-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59935207R00000X, 207RE0101X
AK180459207RE0101X
NY159782207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ07576OtherBLUE CROSS
MA3036014Medicaid
MA0025387OtherNEIGHBORHOOD HEALTH PLAN
MA059935OtherTUFTS HEALTH PLAN
MA3944OtherFALLON COMMUNITY HEALTH
MAAA78216OtherHARVARD PILGRIM
MA3944OtherFALLON COMMUNITY HEALTH
MAJ07576Medicare PIN