Provider Demographics
NPI:1265295059
Name:MEADE, GAVIN
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:MEADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FORBES ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1809
Mailing Address - Country:US
Mailing Address - Phone:434-466-7989
Mailing Address - Fax:
Practice Address - Street 1:1 WELLS AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3226
Practice Address - Country:US
Practice Address - Phone:617-327-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program