Provider Demographics
NPI:1689663130
Name:GILLESPIE, HAROLD A II (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:A
Last Name:GILLESPIE
Suffix:II
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 1:313 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9555
Mailing Address - Country:US
Mailing Address - Phone:740-743-2039
Mailing Address - Fax:740-743-1283
Practice Address - Street 1:313 NORTH DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783-9555
Practice Address - Country:US
Practice Address - Phone:740-743-2039
Practice Address - Fax:740-743-1283
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082591G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2425987Medicaid
H92939Medicare UPIN
OH2425987Medicaid