Healthcare Provider Details

I. General information

NPI: 1639336423
Provider Name (Legal Business Name): BRIAN M. GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 OBERY ST SUITE 201
PLYMOUTH MA
02360-2229
US

IV. Provider business mailing address

1085 MAIN ST SUITE 201
SOUTH WEYMOUTH MA
02190-1547
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-1560
  • Fax: 508-747-5155
Mailing address:
  • Phone: 781-331-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number238164
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: