Provider Demographics
NPI:1609895820
Name:GIBB, MATTHEW D (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:GIBB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:246 PLEASANT STREET
Mailing Address - Street 2:MEMORIAL BUILDING, WEST, GROUND FLO
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-6070
Mailing Address - Fax:603-227-7555
Practice Address - Street 1:246 PLEASANT STREET
Practice Address - Street 2:MEMORIAL BUILDING, WEST, GROUND FLO
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-6070
Practice Address - Fax:603-227-7555
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH16308207RC0000X, 207RI0011X
IL036088393207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270271Medicare PIN
ILL33702Medicare PIN
ILK17172Medicare PIN
IL208905176Medicare PIN
ILF90346Medicare UPIN