Individual
DR. TIMOTHY E GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF PEDIATRIC HOSPITALIST MEDICINE, WORCESTER, MA 01655-0002
(508) 856-3590
(508) 856-7989
Mailing address
PO BOX 415348, BOSTON, MA 02241-0001
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
212163
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
212163
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110005892A
—
MA
01
—
A3400004
MEDICARE
MA
Enumeration date
11/09/2005
Last updated
11/08/2020
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