Provider Demographics
NPI:1790002954
Name:GILLESPIE, JOHN W III (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:GILLESPIE
Suffix:III
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 1:2383 LIMESTONE RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-274-2996
Mailing Address - Fax:302-274-2987
Practice Address - Street 1:2383 LIMESTONE RD
Practice Address - Street 2:2ND FL
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-274-2996
Practice Address - Fax:302-274-2987
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0012570208200000X
DE1790002954208600000X
DEC10012570208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery