Provider Demographics
NPI:1679841555
Name:MARK G GILCHRIST, MD, LLC
Entity Type:Organization
Organization Name:MARK G GILCHRIST, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-250-4081
Mailing Address - Street 1:4 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2766
Mailing Address - Country:US
Mailing Address - Phone:978-250-4081
Mailing Address - Fax:978-250-3956
Practice Address - Street 1:4 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2766
Practice Address - Country:US
Practice Address - Phone:978-250-4081
Practice Address - Fax:978-250-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty