Provider Demographics
NPI:1043286115
Name:GITLIN, JOAN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:GITLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:575 TURNPIKE ST
Mailing Address - Street 2:SUITE 25
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5924
Mailing Address - Country:US
Mailing Address - Phone:978-683-7770
Mailing Address - Fax:978-683-8968
Practice Address - Street 1:575 TURNPIKE ST
Practice Address - Street 2:SUITE 25
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5924
Practice Address - Country:US
Practice Address - Phone:978-683-7770
Practice Address - Fax:978-683-8968
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA49311208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2076985Medicaid
MA2076985Medicaid