Basic Information
| Provider Information | |||||||||
| NPI: | 1265407787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILMORE | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | LEAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 TAPPAN ST | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024455382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177349947 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 BROOKLINE AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176674344 | ||||||||
| FaxNumber: | 6176677120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2006 | ||||||||
| LastUpdateDate: | 05/04/2012 | ||||||||
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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 | 207ZB0001X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZP0104X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | 207ZC0500X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZH0000X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZI0100X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | 207ZM0300X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZP0105X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207ZN0500X | 35-097770 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | 207ZP0102X | 35-097770 | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0056593 | 05 | OH | MEDICAID |