Provider Demographics
NPI:1114003209
Name:GILMORE, JUDITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0229
Mailing Address - Country:US
Mailing Address - Phone:401-788-8940
Mailing Address - Fax:401-515-2670
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:SUITE G2
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-788-8940
Practice Address - Fax:401-515-2670
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI06935207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200353OtherBLUE CHIP
RI9000265Medicaid
RI265-7OtherBLUE CROSS
RI33-00015OtherUHP
RI41D0084370OtherCLIA
RI06935OtherRI MEDICAL LICENSE
RI0930958OtherAETA
RI0930958OtherAETA
RIC90702Medicare UPIN