Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 59954 | MA |
NPI | 1124053277 |
---|---|
Provider Name | Charles M Gibson |
First Address | Natick, MA 01760-2956 |
Second Address | Boston, MA 02115-5726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |