Basic Information
| Provider Information | |||||||||
| NPI: | 1295029338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILMAN | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST | ||||||||
| Address2: | WOT 2ND FL, STE C203 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952855 | ||||||||
| FaxNumber: | 5084255656 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 NEPONSET ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952855 | ||||||||
| FaxNumber: | 5084255656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2011 | ||||||||
| LastUpdateDate: | 11/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 2014011931 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 277671 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 110148929A | 05 | MA | MEDICAID |