Provider Demographics
NPI:1891864005
Name:GILL, PAUL WESLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WESLEY
Last Name:GILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 RITCHIE HWY STE K
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3926
Mailing Address - Country:US
Mailing Address - Phone:410-544-8433
Mailing Address - Fax:410-544-9026
Practice Address - Street 1:580 RITCHIE HWY STE K
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3926
Practice Address - Country:US
Practice Address - Phone:410-544-8433
Practice Address - Fax:410-544-9026
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1032213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4362987OtherAETNA USHC
MD480030924OtherMEDICARE RAILROAD
FLA824 0001OtherDC BLUE CROSS FEP
MDUNITED HEALTH CAREOther339009
MD40147604OtherCAREFIRST MD
FLA824 0001OtherDC BLUE CROSS FEP
MD1113440001Medicare NSC
MD40147604OtherCAREFIRST MD