Provider Demographics
NPI:1336145903
Name:GILLELAND, WILLIAM NORTHWOOD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NORTHWOOD
Last Name:GILLELAND
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:26 NESBITT RD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3410
Mailing Address - Country:US
Mailing Address - Phone:724-652-3616
Mailing Address - Fax:724-656-6679
Practice Address - Street 1:26 NESBITT RD
Practice Address - Street 2:SUITE 151
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3410
Practice Address - Country:US
Practice Address - Phone:724-652-3616
Practice Address - Fax:724-656-6679
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD046830L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014666800001Medicaid
PA122440OtherMEDICARE ID
PA0014666800005Medicaid
PA0014666800005Medicaid