Provider Demographics
NPI:1053387316
Name:GIRGIS, GIGI (MD)
Entity type:Individual
Prefix:DR
First Name:GIGI
Middle Name:
Last Name:GIRGIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOPE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2721
Mailing Address - Country:US
Mailing Address - Phone:781-647-3550
Mailing Address - Fax:781-899-8845
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2721
Practice Address - Country:US
Practice Address - Phone:781-647-3550
Practice Address - Fax:781-899-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA507992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3000494Medicaid
MAA59814Medicare UPIN
MAJ04851Medicare ID - Type Unspecified