Provider Demographics
NPI:1508856071
Name:BOUTWELL, GINA S (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:S
Last Name:BOUTWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:SERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD FAAP
Mailing Address - Street 1:600 LONGWATER DR FL 2
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1639
Mailing Address - Country:US
Mailing Address - Phone:781-745-3322
Mailing Address - Fax:781-561-0610
Practice Address - Street 1:600 LONGWATER DR FL 2
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1639
Practice Address - Country:US
Practice Address - Phone:781-745-3322
Practice Address - Fax:781-561-0610
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042297845OtherUNITED HEALTH CARE
MA201609OtherHVD PILGRIM HEALTH CARE
MA5303578OtherAETNA
MA042297845OtherGIC UNICARE
MA6030047OtherCIGNA
MA0016419OtherNEIGHBORHOOD HLTH PLAN
MA042297845OtherTRICARE
MA042297845OtherHCVM
MA3168531Medicaid
MA34696OtherFALLON
154227OtherTUFTS - HMO
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MA154227OtherTUFTS MEDICARE PREFERRED
MA154227OtherTUFTS
MAJ17820OtherBCBS
MA042297845OtherHCVM
154227OtherTUFTS - HMO
MAA22658Medicare PIN