Provider Demographics
NPI:1831193101
Name:EATON, ANTHONY GIBRAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GIBRAN
Last Name:EATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5044
Mailing Address - Country:US
Mailing Address - Phone:978-208-4756
Mailing Address - Fax:978-686-6584
Practice Address - Street 1:87 JACKSON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5044
Practice Address - Country:US
Practice Address - Phone:978-208-4756
Practice Address - Fax:978-686-6584
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2061546Medicaid
MA469196OtherTUFTS HEALTH PLAN
MAJ27682OtherBLUE CROSS BLUE SHIELD
MAAA13929OtherHARVARD PILGRIM HEALTHCAR
MAI07779Medicare UPIN
MAA36803Medicare ID - Type Unspecified