Provider Demographics
NPI:1467444265
Name:GILLILAND, MARY GF (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:GF
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:ECU PHYSICIANS PATHOLOGY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-2803
Practice Address - Fax:252-744-3616
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC37832207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935559Medicaid
NC220020369OtherRAILROAD MEDICARE
NC35559OtherBCBS NC
NC8935559Medicaid
NC220020369OtherRAILROAD MEDICARE