Provider Demographics
NPI:1922067578
Name:GILL, CAROL L (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:GILL
Other - Last Name:DAVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11875 DUBLIN BLVD
Mailing Address - Street 2:SUITE C140
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2843
Mailing Address - Country:US
Mailing Address - Phone:925-558-7250
Mailing Address - Fax:925-587-2511
Practice Address - Street 1:1134 MURRIETA BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4190
Practice Address - Country:US
Practice Address - Phone:925-449-7795
Practice Address - Fax:925-449-7953
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F55122Medicare UPIN