Gibson, Timothy E

Gibson, Timothy E is an individual health care provider with primary practice located at 55 Lake Ave N Department Of Pediatric Hospitalist Medicine, Worcester MA 01655-0002. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Gibson, Timothy E can be contacted via phone (508) 856-3590.

Contact Information

Primary practice address
55 Lake Ave N Department Of Pediatric Hospitalist Medicine Worcester MA 01655-0002
Phone: (508) 856-3590
Fax: (508) 856-7989
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine 2080P0204X 212163 Massachusetts
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 212163 Massachusetts

Profile Details

NPI number 1336120062
LBN Legal business name Gibson, Timothy E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2005
Last updated Nov 8th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336120062 NPPES
Massachusetts MEDICAID 110005892A
Massachusetts Other A3400004

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