Provider Demographics
NPI:1093770364
Name:GILL, CHARLOTTE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET
Mailing Address - Street 2:PATHOLOGY DEPARTMENT; MS117
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-5425
Mailing Address - Fax:859-257-7572
Practice Address - Street 1:PATHOLOGY DEPT MS 117
Practice Address - Street 2:800 ROSE STREET
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-323-5425
Practice Address - Fax:859-257-7572
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY31297207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64051162Medicaid
TN3833977Medicaid
TN3833977Medicaid
TN3833977Medicare PIN
TNP00431451Medicare PIN