Provider Demographics
NPI:1548238017
Name:GILL, ROY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:A
Last Name:GILL
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:PO BOX 183103
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1405 SOUTH HIGH ST.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206
Practice Address - Country:US
Practice Address - Phone:614-293-3330
Practice Address - Fax:614-293-3336
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP976207Q00000X
OH35.089215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100017200Medicaid
OH2752712Medicaid
1548238017OtherNPI
E52926Medicare UPIN
OH4233611Medicare PIN
KY7100017200Medicaid