MEDICARE: DR. CLAUDIA CAVAGNARO GIBSON 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	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	6211	NH
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	6211	NH

General Provider Information

NPI Number	:	1669573481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAUDIA CAVAGNARO GIBSON M.D.

Provider Business Mailing Address
First Line	:	33 E WILDER RD
Second Line	:
City	:	WEST LEBANON
State	:	NH
Zip	:	03784-3106
Country	:	US
Telephone Number	:	603-443-0104
Fax Number	:	266-543-0623

Provider Business Practice Location Address
First Line	:	33 E WILDER RD
Second Line	:
City	:	WEST LEBANON
State	:	NH
Zip	:	03784-3106
Country	:	US
Telephone Number	:	603-443-0104
Fax Number	:	866-543-0623

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	10/04/2013

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