Provider Demographics
NPI:1306024476
Name:GILLIS, THERESA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:GILLIS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:68 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4300
Mailing Address - Country:US
Mailing Address - Phone:301-694-5292
Mailing Address - Fax:301-694-2319
Practice Address - Street 1:68 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4300
Practice Address - Country:US
Practice Address - Phone:301-694-5292
Practice Address - Fax:301-694-2319
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2023-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant