MEDICARE: PETER M GIBSON PH.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	103T00000X	Psychologist	PSY1191	DC
2	103T00000X	Psychologist	0810-001063	VA

General Provider Information

NPI Number	:	1871678771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER M GIBSON PH.D.

Provider Business Mailing Address
First Line	:	1350 CONNECTICUT AVE NW
Second Line	:	SUITE 603
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 CONNECTICUT AVE NW
Second Line	:	SUITE 603
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1722
Country	:	US
Telephone Number	:	202-775-1556
Fax Number	:

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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Directions to “ PETER M GIBSON PH.D.” Practice Location

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