Provider Demographics
NPI:1093762601
Name:GIBBONS, CHRISTOPHER H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:H
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 DEACONESS RD
Mailing Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER, PALMER 111
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5321
Mailing Address - Country:US
Mailing Address - Phone:617-632-8454
Mailing Address - Fax:617-632-0852
Practice Address - Street 1:1 DEACONESS RD
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER, PALMER 111
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5321
Practice Address - Country:US
Practice Address - Phone:617-632-8454
Practice Address - Fax:617-632-0852
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-05-02
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Provider Licenses
StateLicense IDTaxonomies
MA2205252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA21246423448OtherBEECH STREET
MAAA14162OtherHARVARD PILGRIM HC 1
MA70010000J27636OtherHMO BLUE NETWORK BLUE
MA0033246OtherNEIGHBORHOOD HEALTH PLAN
MA70010000J27636OtherBLUE CARE ELECT
MA90387OtherFALLON
MAAA22089OtherHARVARD PILGRIM HC 2
ME2078813Medicaid
MA3654408OtherAETNA HMO2
MA05-00984OtherUNITED HEALTHCARE 1
MA70010000J27636OtherBLUE CROSS/BLUE SHIELD IN
MA7488577OtherAETNA NONHMO
MA3545778OtherAETNA HMO1
MA70010000J27636OtherBCBS DIAGNOSTIC IMAGING
MA70010000J27636OtherBLUE CARE 65
MA05-01144OtherEVERCARE
MA469158OtherTUFTS ASS. HEALTH PLANS
MA5517909-001OtherCIGNA PAL 1
MA970771OtherNETWORK HEALTH
MA5517909-001OtherCIGNA PAL 1