MEDICARE: DR. GLEN R GIBSON MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	D0062550	MD

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2137029	OTHER	MAMSI
2	64670901	OTHER	BCBS
3	64670903	OTHER	BCBS (HOS)
4	K5850009	OTHER	BCBS DC
5	102077	OTHER	JHHC
6	1703604	OTHER	AMERICHOICE
7	2363265	OTHER	UNITED HEALTHCARE
8	3758040	OTHER	CIGNA
9	3943260	OTHER	AETNA HMO
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	254989	OTHER	KAISER
12	7105042	OTHER	AETNA PPO
13	287909	OTHER	AMERIGROUP
14	145726104	OTHER	FEDERAL WORKMAN'S COMP (ANNE ARUNDEL MEDICAL CENTER)
15	64670908	OTHER	BCBS
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	610307700	OTHER	FEDERAL WORKMANS COMP
18	0001	OTHER	BCBS
19	64670904	OTHER	BCBS (HOS)

NPI Number	:	1609874973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN R GIBSON MD

Provider Business Mailing Address
First Line	:	PO BOX 12622
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4017
Country	:	US
Telephone Number	:	443-481-6538
Fax Number	:	443-481-6515

Provider Business Practice Location Address
First Line	:	2003 MEDICAL PKWY
Second Line	:	SUITE 301
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7992
Country	:	US
Telephone Number	:	410-266-9966
Fax Number	:	410-266-6819

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/05/2013

2003 MEDICAL PKWY , 102
ANNAPOLIS, MD
21401-7992

Practice Phone: 443-481-1000
Practice Fax: