Provider Demographics
NPI:1912173527
Name:GENTILE, MARK ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:GENTILE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ARBOR DR STE H
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6688
Mailing Address - Country:US
Mailing Address - Phone:540-381-8700
Mailing Address - Fax:540-381-8700
Practice Address - Street 1:360 ARBOR DR STE H
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6688
Practice Address - Country:US
Practice Address - Phone:540-381-8700
Practice Address - Fax:540-381-8700
Is Sole Proprietor?:No
Enumeration Date:2008-05-03
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002024111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001042Medicare PIN
VAT55064Medicare UPIN
VAC09508Medicare PIN