Healthcare Provider Details

I. General information

NPI: 1134199490
Provider Name (Legal Business Name): MATTHEW D GILMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL DEPT OF RADIOLOGY 55 FRUIT STREET, FND 202
BOSTON MA
02114
US

IV. Provider business mailing address

4 LONGFELLOW PL UNIT 802
BOSTON MA
02114-2838
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4254
  • Fax: 617-724-4254
Mailing address:
  • Phone: 617-724-4254
  • Fax: 617-724-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number219932
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number219932
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: