Provider Demographics
NPI:1700881406
Name:GILES, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:GILES
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 1:56 MOUNTAIN TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1533
Mailing Address - Country:US
Mailing Address - Phone:860-521-5600
Mailing Address - Fax:
Practice Address - Street 1:CHARLOTTE HUNGERFORD HOSPITAL
Practice Address - Street 2:540 LITCHFIELD ROAD
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-0988
Practice Address - Country:US
Practice Address - Phone:860-496-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0371022086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1700881406Medicaid
CTD400007952Medicare PIN