Provider Demographics
NPI:1063539328
Name:RALLS, GILLIAN D (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:D
Last Name:RALLS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 208237
Mailing Address - Street 2:55 LOCK STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520
Mailing Address - Country:US
Mailing Address - Phone:203-432-0312
Mailing Address - Fax:203-432-7289
Practice Address - Street 1:55 LOCK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3603
Practice Address - Country:US
Practice Address - Phone:203-432-7978
Practice Address - Fax:203-432-7828
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000234363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical