Provider Demographics
NPI:1629221965
Name:TRINITY FAMILY MEDICINE
Entity Type:Organization
Organization Name:TRINITY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-230-0155
Mailing Address - Street 1:3 WASHINGTON ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1034
Mailing Address - Country:US
Mailing Address - Phone:508-230-0155
Mailing Address - Fax:508-230-0145
Practice Address - Street 1:3 WASHINGTON ST STE 220
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1034
Practice Address - Country:US
Practice Address - Phone:508-230-0155
Practice Address - Fax:508-230-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2083361Medicaid
MA2083361Medicaid