Individual
BETHANY GENTILESCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2853
(401) 793-2104
(401) 793-4047
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A81998
CA
207R00000X
Internal Medicine Physician
Primary
MD12242
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689749
—
RI
05
—
1689749822
—
RI
01
—
32947-5
BCBS RI
RI
01
—
413923
BLUECHIP
RI
01
—
AA99999
HPHC
RI
Enumeration date
11/22/2006
Last updated
03/05/2026
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