Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 62519 | CT |
N | 111NI0900X | Internist | 62519 | CT |
Y | 207RA0401X | Internist - Addiction Medicine | 283531 | MA |
N | 207RA0401X | Internist - Addiction Medicine | 62519 | CT |
NPI | 1306294764 |
---|---|
Provider Name | Dr. Evan Dov Gale |
First Address | Boston, MA 02114-2621 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004217099 | (05) | CT |
008087608 | (05) | CT |