Provider Demographics
NPI:1407939077
Name:GAINES, JILL A (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:GAINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:21 HIGHLAND AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2201
Mailing Address - Country:US
Mailing Address - Phone:540-982-8881
Mailing Address - Fax:540-982-0501
Practice Address - Street 1:21 HIGHLAND AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2201
Practice Address - Country:US
Practice Address - Phone:540-982-8881
Practice Address - Fax:540-982-0501
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200300786207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135F6Medicaid
SCN0078AMedicaid
NCP00391091OtherRAILROAD MEDICARE
NC89135F6Medicaid
VA019380P00Medicare Oscar/Certification