Provider Demographics
NPI:1750451662
Name:O'SHAUGHNESSY, GILLIAN DOLORES ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:DOLORES ROSE
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:504 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7919
Mailing Address - Country:US
Mailing Address - Phone:612-961-9387
Mailing Address - Fax:
Practice Address - Street 1:920 EAST 28TH STREET SUITE # 190
Practice Address - Street 2:ABBOTT NORTHWESTERN HOSPITALIST SERVICE OF THE AMC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-863-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN48719207R00000X
NY278157-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY278157-1OtherMEDICAL LICENSE
MN48719OtherLICENSE