Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 12174 | MA |
NPI | 1134128218 |
---|---|
Provider Name | Thomas G Gelsinon |
First Address | Marlborough, MA 01752-1207 |
Second Address | Marlborough, MA 01752-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0263087 | (05) | MA |
T57104 | (02) |