MEDICARE: SARAH JANE GIBBONS 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	208000000X	Pediatrics Physician	24012	NH

General Provider Information

NPI Number	:	1780211201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JANE GIBBONS MD

Provider Business Mailing Address
First Line	:	330 BORTHWICK AVE STE 101
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4102
Country	:	US
Telephone Number	:	603-714-4519
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 BORTHWICK AVE STE 101
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4102
Country	:	US
Telephone Number	:	603-714-4519
Fax Number	:

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	10/07/2024

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