Provider Demographics
NPI:1679350623
Name:MARIE GIPSON MD PLLC
Entity type:Organization
Organization Name:MARIE GIPSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIH
Authorized Official - Middle Name:YEE-MARIE TAN
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-326-5102
Mailing Address - Street 1:18 GROVE ST # 6
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7705
Mailing Address - Country:US
Mailing Address - Phone:617-326-5102
Mailing Address - Fax:617-858-8238
Practice Address - Street 1:18 GROVE ST # 6
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7705
Practice Address - Country:US
Practice Address - Phone:617-326-5102
Practice Address - Fax:617-858-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty