Basic Information
Provider Information
NPI: 1003005174
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILMAN
FirstName: DAVID
MiddleName: M.
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 540 N DUKE ST
Address2: STE 244
City: LANCASTER
State: PA
PostalCode: 176022374
CountryCode: US
TelephoneNumber: 7178269781
FaxNumber: 7179455177
Practice Location
Address1: 3400 SPRUCE ST
Address2: 2 DULLES
City: PHILADELPHIA
State: PA
PostalCode: 191044238
CountryCode: US
TelephoneNumber: 2156622277
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/15/2007
LastUpdateDate: 03/15/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA057342PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X2386MAN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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