Provider Demographics
NPI:1679638324
Name:GILBERT, MARIE T (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:T
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NEW ROCHESTER RD 2
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-8800
Mailing Address - Country:US
Mailing Address - Phone:603-742-6555
Mailing Address - Fax:603-742-2908
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-8800
Practice Address - Country:US
Practice Address - Phone:603-742-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000236Medicaid
NH04482901OtherANTHEM BLUE CROSS
NH3096838Medicaid
NH798699OtherMVP
NH970018851OtherRAILROAD MEDICARE
NH9756546OtherCIGNA
S43111Medicare UPIN
NH798699OtherMVP