Provider Demographics
NPI:1689729212
Name:GAILLARD, STEPHANIE LOUISE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:GAILLARD
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Gender:F
Credentials:MD, PHD
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Other - First Name:
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Mailing Address - Street 1:9910 FRANKLIN SQUARE DRIVE
Mailing Address - Street 2:2110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-933-6423
Practice Address - Street 1:401 N BROADWAY
Practice Address - Street 2:ROOM 1361
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231
Practice Address - Country:US
Practice Address - Phone:410-955-3707
Practice Address - Fax:410-955-8587
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD69970207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD116742100Medicaid