Provider Demographics
NPI:1093808495
Name:JASON M GILBERT MD PC
Entity Type:Organization
Organization Name:JASON M GILBERT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-395-9916
Mailing Address - Street 1:101 MAIN STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-395-9916
Mailing Address - Fax:781-395-9960
Practice Address - Street 1:101 MAIN STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-395-9916
Practice Address - Fax:781-395-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71013207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17721OtherBLUE SHIELD
MA9787267Medicaid
E40344Medicare UPIN
MA9787267Medicaid