Provider Demographics
NPI:1437166881
Name:GILLARD, STEPHEN CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:GILLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6022
Mailing Address - Country:US
Mailing Address - Phone:781-762-0471
Mailing Address - Fax:781-762-8072
Practice Address - Street 1:51 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2129
Practice Address - Country:US
Practice Address - Phone:508-732-6770
Practice Address - Fax:508-732-2129
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80236174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19168OtherBCBS
MA28167OtherHARVARD PILGRIM
MA3184340Medicaid
MA080236OtherTUFTS
MA080236OtherTUFTS
MAG72952Medicare UPIN