Provider Demographics
NPI:1225026099
Name:CARLINE-GILKINSON, MARYLIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYLIDA
Middle Name:
Last Name:CARLINE-GILKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYLIDA
Other - Middle Name:
Other - Last Name:CARLINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1236 E ELIZABETH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4000
Mailing Address - Country:US
Mailing Address - Phone:970-224-2985
Mailing Address - Fax:970-472-9381
Practice Address - Street 1:1236 E ELIZABETH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4000
Practice Address - Country:US
Practice Address - Phone:970-224-2985
Practice Address - Fax:970-472-9381
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6095207L00000X
WY6722A207L00000X
CODR.0031232207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104576800Medicaid
CO01312321Medicaid
WA0240560OtherWORKMANS COMP
CO050072307Medicare PIN
WA0240560OtherWORKMANS COMP
WY104576800Medicaid