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:
Health care specialties
| Specialty | Code | License # | 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 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336120062 | NPPES |
| Massachusetts | MEDICAID | 110005892A | |
| Massachusetts | Other | A3400004 |
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