MEDICARE: BRIAN M. GILL M.D.

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	207RG0100X	Gastroenterology Physician	238164	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	:	1639336423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN M. GILL M.D.

Provider Business Mailing Address
First Line	:	1085 MAIN ST
Second Line	:	SUITE 201
City	:	SOUTH WEYMOUTH
State	:	MA
Zip	:	02190-1547
Country	:	US
Telephone Number	:	781-331-2922
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 OBERY ST
Second Line	:	SUITE 201
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2229
Country	:	US
Telephone Number	:	508-747-1560
Fax Number	:	508-747-5155

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	03/23/2017

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