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General NPI Number Information
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NPI Number | 1609874973
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Entity Type | Individual
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Provider Name | GLEN R GIBSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 2003 MEDICAL PKWY SUITE 301
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7992
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Country | US
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Telephone | 410-266-9966
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Fax | 410-266-6819
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Provider Business Mailing Address
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Address Line | PO BOX 12622
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City | BELFAST
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State | ME
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Zip | 04915-4017
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Country | US
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Telephone | 443-481-6538
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Fax | 443-481-6515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | D0062550
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License Number State | MD
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