Provider Demographics
NPI:1083757553
Name:GILPATRICK, MARTHA W (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:W
Last Name:GILPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 REVOLUTIONARY RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2616
Mailing Address - Country:US
Mailing Address - Phone:781-724-9086
Mailing Address - Fax:
Practice Address - Street 1:140 REVOLUTIONARY RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2616
Practice Address - Country:US
Practice Address - Phone:781-724-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine