Active NPI
Ethan Gershon, MD
- General Practice Physician
- Needham, MA
National Provider Identifier
1629588389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 2004008251
- Practice address
- 375 Hunnewell St
Needham, MA 02494-1340 - Phone
- (508) 665-9475
- NPI assigned
- Oct 9, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 2004008251 | MO | Primary |
Addresses
Primary practice location
375 Hunnewell St
Needham, MA 02494-1340
Mailing address
375 Hunnewell St
Needham, MA 02494-1340
Phone (508) 665-9475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004008251 | MO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556582400000",
"number": "1629588389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 HUNNEWELL ST",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024941340",
"telephone_number": "508-665-9475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 HUNNEWELL ST",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024941340",
"telephone_number": "508-665-9475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERSHON",
"first_name": "ETHAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-09",
"last_updated": "2019-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MO",
"license": "2004008251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Needham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.