Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1763 | ME |
NPI | 1619960945 |
---|---|
Provider Name | Dr. Thomas M Gilson |
First Address | Falmouth, ME 04105 |
Second Address | Falmouth, ME 04105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 28/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H60646 | (02) | |
MM7221 | (02) | |
MM7302 | MEDICARE ID - GROUP (01) |