Angelica Brooke Elizabeth Gentile
Individual provider Active NPI Contractor · Saugus, MA
NPI 1457050833 · NPPES record last updated Feb 24, 2023
Key facts
- NPI
- 1457050833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 5011635 (MA)
- Practice address
- 5 Broadway
Saugus, MA 01906-1057 - Phone
- (781) 233-9787
- NPI assigned
- Feb 24, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5011635 | MA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 5011635 | MA | Yes |
Addresses
Primary practice location
5 Broadway
Saugus, MA 01906-1057
Mailing address
5 Broadway
Saugus, MA 01906-1057
Phone (781) 233-9787
Other providers in Saugus, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.