Provider Demographics
NPI:1063474336
Name:GILLE, THERESA MARY (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARY
Last Name:GILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 455 BOX 208
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96540-0003
Mailing Address - Country:US
Mailing Address - Phone:671-682-8996
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL GUAM
Practice Address - Street 2:BLDG 50, FARENHOLT AVENUE
Practice Address - City:AGANAHEIGHTS, GUAM
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-344-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMD-P-2023-002207Y00000X
VA0101240253207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology