Provider Demographics
NPI:1013908417
Name:GILL, T DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:T
Middle Name:DAVID
Last Name:GILL
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 1:435 FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2328
Mailing Address - Country:US
Mailing Address - Phone:781-837-1108
Mailing Address - Fax:781-837-1109
Practice Address - Street 1:435 FURNACE ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2328
Practice Address - Country:US
Practice Address - Phone:781-837-1108
Practice Address - Fax:781-837-1109
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33485208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0156531OtherMASSHEALTH
1240260OtherUNITED
703473OtherTUFTS
MA20073OtherHPHC
400027OtherTUFTS USFHP
MAGIM08315OtherBCBS
MA00156531Medicaid
355287OtherCIGNA
MA20073OtherHPHC
400027OtherTUFTS USFHP