Healthcare Provider Details

I. General information

NPI: 1184625428
Provider Name (Legal Business Name): MARK GORDON GILCHRIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEETING HOUSE RD
CHELMSFORD MA
01824-2766
US

IV. Provider business mailing address

4 MEETING HOUSE RD
CHELMSFORD MA
01824-2766
US

V. Phone/Fax

Practice location:
  • Phone: 978-250-4081
  • Fax: 978-250-3956
Mailing address:
  • Phone: 978-250-4081
  • Fax: 978-250-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number223713
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: