Provider Demographics
NPI:1164117909
Name:GILLAN, GRANT (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:GILLAN
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 1:117 SOUTH 11TH STREET
Mailing Address - Street 2:204 PAVILION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-503-3876
Mailing Address - Fax:215-955-2519
Practice Address - Street 1:117 SOUTH 11TH STREET
Practice Address - Street 2:204 PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-503-3876
Practice Address - Fax:215-955-2519
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program