Provider Demographics
NPI:1538390232
Name:GIBSON, CHARMAINE C (MD)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:C
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:C
Other - Last Name:SESAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4278
Mailing Address - Country:US
Mailing Address - Phone:972-231-9144
Mailing Address - Fax:972-231-9174
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 400
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4278
Practice Address - Country:US
Practice Address - Phone:972-231-9144
Practice Address - Fax:972-231-9174
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449331207V00000X
FLME123543207V00000X
TXQ6142207VX0000X
PAMT195157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392498701Medicaid