Provider Demographics
NPI:1376575712
Name:GILBOA, RAANAN (MD)
Entity Type:Individual
Prefix:
First Name:RAANAN
Middle Name:
Last Name:GILBOA
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 1:214 RUMFORD AVE
Mailing Address - Street 2:APT 404
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2175
Mailing Address - Country:US
Mailing Address - Phone:716-430-2835
Mailing Address - Fax:
Practice Address - Street 1:100 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-7395
Practice Address - Country:US
Practice Address - Phone:508-822-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA56606OtherHEALTH NEW ENGLAND
MAAA285101OtherHARVARD PILGRIM
MA3616754OtherCIGNA
MA56606OtherHEALTH NEW ENGLAND