Provider Demographics
NPI:1831393222
Name:GILGORE, LLOYD A (PSYD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:A
Last Name:GILGORE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3837
Mailing Address - Country:US
Mailing Address - Phone:215-345-5245
Mailing Address - Fax:941-697-5168
Practice Address - Street 1:200 NORTH ST STE A
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3837
Practice Address - Country:US
Practice Address - Phone:215-345-5245
Practice Address - Fax:941-697-5168
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAP.S.005786L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA652400OtherPENNSYLVANIA BLUE SHIELD
PAMC652400Medicare ID - Type Unspecified