Individual
GENTRY W THATCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
198 MASSACHUSETTS AVE #103, N ANDOVER, MA 01845
(978) 685-7550
(978) 686-5565
Mailing address
198 MASSACHUSETTS AVE #103, N ANDOVER, MA 01845
(978) 685-7550
(978) 686-5565
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
11012
NH
207Y00000X
Otolaryngology Physician
Primary
204712
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0020548
NHP
—
05
—
0104914
—
MA
01
—
01Y002475MA01
NH BS
—
01
—
040015652
MC RR
—
01
—
10-00243
UNITED HC
—
01
—
19901
H/PIL
—
01
—
204712
SECURE HORIZ
—
01
—
2344337
AETNA/USHC
—
01
—
65475
FALLON
—
01
—
7439118-001
CIGNA PAL
—
01
—
76754
AAO/HNS
—
01
—
976854
NETWORK HEALTH
—
01
—
B20973001
CIGNA
—
01
—
J22387
BS-HMO
—
Enumeration date
08/12/2005
Last updated
03/07/2023
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