Provider Demographics
NPI:1861038465
Name:JMG MACIPA LLC
Entity Type:Organization
Organization Name:JMG MACIPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-395-9916
Mailing Address - Street 1:101 MAIN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4530
Mailing Address - Country:US
Mailing Address - Phone:781-395-9916
Mailing Address - Fax:781-395-9960
Practice Address - Street 1:101 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4530
Practice Address - Country:US
Practice Address - Phone:781-395-9916
Practice Address - Fax:781-395-9960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASON M. GILBERT, M.D.P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-19
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty