Provider Demographics
NPI:1881614675
Name:GILL, HARWANT S (MD PHD)
Entity type:Individual
Prefix:
First Name:HARWANT
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:HARRY
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:205 APPLEGATE RD STE 1001133
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-6502
Mailing Address - Country:US
Mailing Address - Phone:215-543-3488
Mailing Address - Fax:155-433-4882
Practice Address - Street 1:205 APPLEGATE RD STE 1001133
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6502
Practice Address - Country:US
Practice Address - Phone:155-433-4882
Practice Address - Fax:215-543-3488
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4662582084P0800X
VA01012736782084P0800X
NY3215332084P0800X
MDD00582112084P0800X
DCMD341022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2276687OtherFIRSTHEALTH
DC2190381OtherCIGNA
DC034804300Medicaid
MD699967100Medicaid
DC2190381OtherCIGNA
DC034804300Medicaid