Healthcare Provider Details

I. General information

NPI: 1679350623
Provider Name (Legal Business Name): MARIE GIPSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 GROVE ST # 6
WELLESLEY MA
02482-7705
US

IV. Provider business mailing address

18 GROVE ST # 6
WELLESLEY MA
02482-7705
US

V. Phone/Fax

Practice location:
  • Phone: 617-326-5102
  • Fax: 617-858-8238
Mailing address:
  • Phone: 617-326-5102
  • Fax: 617-858-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIH YEE-MARIE TAN GIPSON
Title or Position: OWNER
Credential: MD
Phone: 617-326-5102