Provider Demographics
NPI:1508031857
Name:GILDER, MARY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:GILDER
Suffix:
Gender:F
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:SMRU
Mailing Address - Street 2:68/30 BANTUNG ROAD, PO BOX 46
Mailing Address - City:MAE SOT
Mailing Address - State:TAK
Mailing Address - Zip Code:63110
Mailing Address - Country:TH
Mailing Address - Phone:665-554-5021
Mailing Address - Fax:665-554-5020
Practice Address - Street 1:SMRU
Practice Address - Street 2:68/30 BANTUNG ROAD
Practice Address - City:MAE SOT
Practice Address - State:TAK
Practice Address - Zip Code:63110
Practice Address - Country:TH
Practice Address - Phone:665-554-5021
Practice Address - Fax:665-554-5020
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program