Provider Demographics
NPI:1770673477
Name:GILMAN, ANDREW L (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:GILMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-381-9900
Mailing Address - Fax:704-381-8848
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:MEDICAL CENTER PLAZA, SUITE 601
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5866
Practice Address - Country:US
Practice Address - Phone:704-381-9900
Practice Address - Fax:704-381-8848
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2004-010612080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1770673477Medicaid
NC89137YUMedicaid
SCN0106DOtherSC MEDICAID
SCN0106DOtherSC MEDICAID
NC89137YUMedicaid
NC1770673477Medicaid