Provider Demographics
NPI:1093580599
Name:GILPIN, MARK DAVID (CCP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:GILPIN
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 FIRESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6469
Mailing Address - Country:US
Mailing Address - Phone:317-281-8605
Mailing Address - Fax:
Practice Address - Street 1:633 FIRESIDE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6469
Practice Address - Country:US
Practice Address - Phone:317-281-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist