Provider Demographics
NPI:1124102637
Name:PRANSKY, GARY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEVEN
Last Name:PRANSKY
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 1:52 CREST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1064
Mailing Address - Country:US
Mailing Address - Phone:617-846-8622
Mailing Address - Fax:617-846-8498
Practice Address - Street 1:52 CREST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1064
Practice Address - Country:US
Practice Address - Phone:617-846-8622
Practice Address - Fax:617-846-8498
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0106569Medicaid
MAA36996Medicare UPIN
MAB54047Medicare ID - Type Unspecified