Provider Demographics
NPI:1801885918
Name:GIBNEY, MARY D (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:D
Last Name:GIBNEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:280 MERRIMACK ST STE 311
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1779
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:198 MASSACHUSETTS AVE STE 105
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4143
Practice Address - Country:US
Practice Address - Phone:978-691-5690
Practice Address - Fax:978-691-5693
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA150484207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3152243Medicaid
MA3152243Medicaid
MAG25749Medicare UPIN