Provider Demographics
NPI:1326475864
Name:VANBLERK, GILLIAN ANN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:ANN
Last Name:VANBLERK
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 ETON WAY
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1512
Mailing Address - Country:US
Mailing Address - Phone:410-721-1429
Mailing Address - Fax:
Practice Address - Street 1:1657 ETON WAY
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1512
Practice Address - Country:US
Practice Address - Phone:410-721-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00233572083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine