Provider Demographics
NPI:1558448621
Name:GILMORE, CLYDE ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:ALFRED
Last Name:GILMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2413
Mailing Address - Country:US
Mailing Address - Phone:845-352-7003
Mailing Address - Fax:845-371-1841
Practice Address - Street 1:BELLEVUE HOSPITAL CENTER
Practice Address - Street 2:462 1ST AVENUE, H-12E19
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-7729
Practice Address - Fax:212-562-8422
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY493729Medicaid
NY493729Medicaid