Provider Demographics
NPI:1639336423
Name:GILL, BRIAN M (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1085 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1547
Mailing Address - Country:US
Mailing Address - Phone:781-331-2922
Mailing Address - Fax:
Practice Address - Street 1:47 OBERY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2229
Practice Address - Country:US
Practice Address - Phone:508-747-1560
Practice Address - Fax:508-747-5155
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA238164207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084458AMedicaid
001197901Medicare PIN