Individual
KATHLEEN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-7595
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-7595
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
96-01616
NC
207ZP0101X
Anatomic Pathology Physician
Primary
96-01616
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1169V
BCBS
—
05
—
2003690000
—
WV
01
—
46204
PARTNERS
—
05
—
6608167
—
VA
01
—
7572345
AETNA
—
05
—
891169V
—
NC
01
—
B3049
MEDCOST
—
05
—
Q0161C
—
SC
Enumeration date
12/02/2005
Last updated
08/20/2010
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