Healthcare Provider Details

I. General information

NPI: 1801325683
Provider Name (Legal Business Name): MATTHEW GILMAN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RIVERSIDE ST STE C
NASHUA NH
03062-1396
US

IV. Provider business mailing address

10 E CHAMBERLAIN RD
MERRIMACK NH
03054-4105
US

V. Phone/Fax

Practice location:
  • Phone: 603-881-9990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number0652
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: