Provider Demographics
NPI:1508832627
Name:GILLIAN, GEORGE KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KEVIN
Last Name:GILLIAN
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 1:8988 LORTON STATION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4756
Mailing Address - Country:US
Mailing Address - Phone:703-372-2280
Mailing Address - Fax:703-372-2024
Practice Address - Street 1:8988 LORTON STATION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4756
Practice Address - Country:US
Practice Address - Phone:703-372-2280
Practice Address - Fax:703-372-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232748208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA227794ZA1BMedicare PIN
VAP00072629Medicare PIN
VA00B433A34Medicare PIN