Healthcare Provider Details

I. General information

NPI: 1932474228
Provider Name (Legal Business Name): KEVIN SYLVAN GIPSON M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAMBRIDGE ST FL 5
BOSTON MA
02114-2743
US

IV. Provider business mailing address

175 CAMBRIDGE ST FL 5
BOSTON MA
02114-2743
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8707
  • Fax: 617-724-2803
Mailing address:
  • Phone: 617-726-8707
  • Fax: 617-724-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number262343
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number262343
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: