Healthcare Provider Details

I. General information

NPI: 1427381359
Provider Name (Legal Business Name): CHRISTOPHER EVAN GIBBONS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 QUEEN CITY AVE
MANCHESTER NH
03101-7121
US

IV. Provider business mailing address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-1655
  • Fax:
Mailing address:
  • Phone: 603-625-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1461
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: