Provider Demographics
NPI:1063588150
Name:GILLIGAN, ROBERT FRANCIS (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:GILLIGAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-3963
Mailing Address - Country:US
Mailing Address - Phone:301-620-7307
Mailing Address - Fax:301-696-1022
Practice Address - Street 1:1052 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-3963
Practice Address - Country:US
Practice Address - Phone:301-620-7307
Practice Address - Fax:301-696-1022
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1169152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD337QMedicare ID - Type Unspecified
MDU61563Medicare UPIN