Provider Demographics
NPI:1508212861
Name:GILLIS, EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:GILLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ERWIN RD BOX 3808 ROOM 1512D1 DUKE HOSPITAL NORTH
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-7272
Mailing Address - Fax:919-684-7129
Practice Address - Street 1:2301 ERWIN RD DUKE HOSPITAL NORTH
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-3931
Practice Address - Country:US
Practice Address - Phone:919-684-7272
Practice Address - Fax:919-684-7129
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT708752085R0202X
NC2021-017022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program