MEDICARE: KENNETH C GORSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	71107	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275528192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH C GORSON MD

Provider Business Mailing Address
First Line	:	110 CEDAR ST
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-3527
Country	:	US
Telephone Number	:	781-591-8300
Fax Number	:	781-591-8320

Provider Business Practice Location Address
First Line	:	110 CEDAR ST
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-3527
Country	:	US
Telephone Number	:	781-591-8300
Fax Number	:	781-591-8320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	11/16/2016

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