Provider Demographics
NPI:1568566842
Name:GILLILAND, DWIGHT GARY (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:GARY
Last Name:GILLILAND
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 1:1 BLACKFAN CIRCLE
Mailing Address - Street 2:ROOM 5210 CHILDRENS HOSPITAL RESEARCH BUILDING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-9092
Mailing Address - Fax:
Practice Address - Street 1:1 BLACKFAN CIRCLE
Practice Address - Street 2:ROOM 5210 CHILDRENS HOSPITAL RESEARCH BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60283207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology