Provider Demographics
NPI:1679684310
Name:GIBSON, MATTHEW HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HOWARD
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BYRKIT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-1158
Mailing Address - Country:US
Mailing Address - Phone:301-582-1150
Mailing Address - Fax:301-582-0905
Practice Address - Street 1:3 BYRKIT DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-1158
Practice Address - Country:US
Practice Address - Phone:301-582-1150
Practice Address - Fax:301-582-0905
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD65001201OtherCAREFIRST BLUE CROSS BLUE
MD053MP247Medicare ID - Type UnspecifiedMEDICARE