Provider Demographics
NPI:1588657787
Name:GAILLIOT, CHRISTOPHER ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:GAILLIOT
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 1:891 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2118
Mailing Address - Country:US
Mailing Address - Phone:937-382-5030
Mailing Address - Fax:937-655-8390
Practice Address - Street 1:891 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2118
Practice Address - Country:US
Practice Address - Phone:937-382-5030
Practice Address - Fax:937-655-8390
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000020457OtherANTHEM
6623201OtherHUMANA CHOICE CARE
OH0261381Medicaid
OH0402744OtherUNITED HEALTHCARE
000000020457OtherIRON WORKERS BENEFIT TRUS
OHGA0764034Medicare PIN
OH000000020457OtherANTHEM
F83378Medicare UPIN
000000020457OtherIRON WORKERS BENEFIT TRUS
OH110191037Medicare PIN
OH110147698Medicare PIN