Individual
MICHAEL D GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4755 OGLETOWN STANTON RD STE 5A43, NEWARK, DE 19718-2200
(302) 623-0188
(302) 733-5640
Mailing address
4755 OGLETOWN STANTON RD STE 5A43, NEWARK, DE 19718-2200
(302) 623-0188
(302) 733-5640
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C1-0024436
DE
208M00000X
Hospitalist Physician
45257
TN
208M00000X
Hospitalist Physician
Primary
C1-0024436
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1522473
—
TN
01
—
4267480
BCBST
TN
05
—
7100104920
—
KY
01
—
P00888532
RAILROAD MEDICARE
TN
Enumeration date
06/11/2007
Last updated
09/14/2021
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