Provider Demographics
NPI:1790747889
Name:GILLESPIE, CAMERON ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:ALEXANDER
Last Name:GILLESPIE
Suffix:
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:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-1337
Mailing Address - Country:US
Mailing Address - Phone:276-236-3210
Mailing Address - Fax:276-236-8780
Practice Address - Street 1:104 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2276
Practice Address - Country:US
Practice Address - Phone:276-236-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010-1026376207YX0007X, 207YX0602X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6501133Medicaid
F67433Medicare UPIN
VA6501133Medicaid