Provider Demographics
NPI:1255406088
Name:GILSTON, RICHARD R (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:GILSTON
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 1:172 KINSLEY ST
Mailing Address - Street 2:SJ EMERGENCY ASSOCIATES
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3648
Mailing Address - Country:US
Mailing Address - Phone:603-578-5090
Mailing Address - Fax:
Practice Address - Street 1:172 KINSLEY ST
Practice Address - Street 2:SJ EMERGENCY ASSOCIATES
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3648
Practice Address - Country:US
Practice Address - Phone:603-578-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0104693Y0NH02OtherANTHEM
44477OtherHARVARD PILGRIM
930050641OtherRAILROAD MEDICARE
MA0194620Medicaid
NHAA137760OtherHARVARD PILGRIM
NH1255406088OtherTUFTS
ME291200099Medicaid
NH30009960Medicaid
NH1255406088OtherBCBS NH
NHRE1103Medicare ID - Type Unspecified
NHCX8956Medicare PIN
NH1255406088OtherBCBS NH
MA0194620Medicaid