Provider Demographics
NPI:1174518294
Name:GALE, MARK ELON (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELON
Last Name:GALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:190 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2019
Mailing Address - Country:US
Mailing Address - Phone:781-444-5955
Mailing Address - Fax:
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY, LOWELL GENERAL HOSPITAL
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-937-6240
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA421732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB95252Medicare UPIN