Provider Demographics
NPI:1376509703
Name:CAMPOS, GERRY (MD)
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0940
Practice Address - Fax:617-770-0526
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54653207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0014796OtherNEIGHBORHOOD HEALTH PLAN
042297845OtherGREAT WEST HEALTH CARE
042297845OtherGIC/UNICARE
MA8166525-003OtherCIGNA
MAG287OtherHARVARD PILGRIM
054653OtherTUFTS MEDICARE PREFERRED
7171302OtherAETNA
042297845OtherTRICARE
MA6194079Medicaid
MAJ04519OtherBLUE CROSS
042297845OtherUNITED HEALTH CARE
042297845OtherHCVM/FIRST HEALTH/COVENTY
MA054653OtherTUFTS HEALTH PLAN
1016764OtherFALLON
042297845OtherTRICARE
MAJ04519OtherBLUE CROSS