Provider Demographics
NPI:1912450933
Name:PAUL W GILL, DPM PC
Entity Type:Organization
Organization Name:PAUL W GILL, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:GILL
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:410-544-8433
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01032213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD529888100Medicaid
MD529888100Medicaid