Provider Demographics
NPI:1649983719
Name:GENTRY, GRACE (DO)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 EMRICK BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8037
Mailing Address - Country:US
Mailing Address - Phone:484-822-5280
Mailing Address - Fax:833-816-5609
Practice Address - Street 1:3101 EMRICK BLVD STE 112
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8037
Practice Address - Country:US
Practice Address - Phone:484-822-5280
Practice Address - Fax:833-816-5609
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2025-06-03
Deactivation Date:2025-05-09
Deactivation Code:
Reactivation Date:2025-05-30
Provider Licenses
StateLicense IDTaxonomies
PAOT024231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine