Provider Demographics
NPI:1285650986
Name:GILLIAM, VALERIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:J
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MILLTOWN RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4084
Mailing Address - Country:US
Mailing Address - Phone:302-993-2330
Mailing Address - Fax:302-993-2344
Practice Address - Street 1:J24 OMEGA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2060
Practice Address - Country:US
Practice Address - Phone:302-738-9100
Practice Address - Fax:302-738-9748
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069883L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003824P97Medicare PIN
DEE91678Medicare UPIN
DE00382G66Medicare PIN
DE003795M26Medicare PIN
DE003794D14Medicare PIN
DE003822B93Medicare PIN
DE003821O73Medicare PIN