Provider Demographics
NPI:1114903176
Name:GILBERT, HENRY TUCKER (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:TUCKER
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1301
Mailing Address - Country:US
Mailing Address - Phone:336-852-3300
Mailing Address - Fax:336-852-0651
Practice Address - Street 1:3801 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1301
Practice Address - Country:US
Practice Address - Phone:336-852-3300
Practice Address - Fax:336-852-0651
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207972085R0202X
VA0101-0263752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016743C19Medicare PIN
213357JMedicare ID - Type Unspecified
C86971Medicare UPIN
NC213357NMedicare PIN