Provider Demographics
NPI:1699160804
Name:DOMBEK, GABRIELLE ELISE (MD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELISE
Last Name:DOMBEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:ELISE
Other - Last Name:CERVONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:330 MOUNT AUBURN ST # 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:617-402-3400
Mailing Address - Fax:
Practice Address - Street 1:300 MOUNT AUBURN ST STE 407
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5665
Practice Address - Country:US
Practice Address - Phone:617-868-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274853208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery