Provider Demographics
NPI:1538409727
Name:GIGI N. GIRGIS, M.D.
Entity type:Organization
Organization Name:GIGI N. GIRGIS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:N
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-647-3550
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ04851OtherMEDICARE ID-TYPE UNSPECIFIED
MA3000494Medicaid
MAA59814Medicare UPIN