Individual
GERALD T. MCGILLICUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
67 BELMONT ST, WORCESTER, MA 01605-2657
(508) 752-4336
(508) 795-0407
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
50103
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110050677A
—
MA
Enumeration date
04/20/2006
Last updated
10/26/2020
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