Provider Demographics
NPI:1306294764
Name:GALE, EVAN DOV (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:DOV
Last Name:GALE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:FOUNDERS 8
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-643-8280
Mailing Address - Fax:617-643-0683
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:FOUNDERS 8
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-8280
Practice Address - Fax:617-643-0683
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT62519207R00000X, 207RA0401X
MA283531207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004217099Medicaid
CT008087608Medicaid