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General NPI Number Information
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NPI Number | 1508859463
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Entity Type | Organization
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Legal Business Name | HIGH PERFORMANCE SPORTS MEDICINE, PC
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 900 CUMMINGS CTR SUITE 130-U
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City | BEVERLY
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State | MA
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Zip | 01915-6198
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Country | US
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Telephone | 978-921-7590
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Fax | 978-921-7597
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Provider Business Mailing Address
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Address Line | 900 CUMMINGS CTR SUITE 130-U
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City | BEVERLY
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State | MA
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Zip | 01915-6198
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Country | US
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Telephone | 978-921-7590
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Fax | 978-921-7597
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK P. GILLIGAN
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Credential | MD
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Telephone | 978-921-7590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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