Healthcare Provider Details

I. General information

NPI: 1083170047
Provider Name (Legal Business Name): GILBERTLAHEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST STE 208
MEDFORD MA
02155-4530
US

IV. Provider business mailing address

101 MAIN ST STE 208
MEDFORD MA
02155-4530
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-9916
  • Fax: 781-395-9960
Mailing address:
  • Phone: 781-395-9916
  • Fax: 781-395-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON M GILBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 781-395-9916