Provider Demographics
NPI:1316935299
Name:ABBOTT, GERALD F (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:F
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION INC
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02114-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-4254
Mailing Address - Fax:617-724-0046
Practice Address - Street 1:55 FRUIT STREET FND 202
Practice Address - Street 2:MGH RADIOLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
007000607OtherHOSPITAL PIN
007600OtherBCBS
300067431OtherRR MEDICARE
007600OtherTUFTS
MA3108449Medicaid
007000607OtherRI MEDICAL ASSISTANCE
1600203OtherUNITED HEALTH PLANS
003116432OtherCT MED ASSISTANCE
240003OtherRIH PILGRIM
720052401OtherCIGNA
3108449OtherHEALTHY START
004384OtherBLUE CHIP
240165OtherW AND I PILGRIM
7600OtherFEP BLUE CROSS
000000001988OtherNHPRI
003116432OtherCT MED ASSISTANCE
004384OtherBLUE CHIP