Provider Demographics
NPI:1215943634
Name:GILMAN, PAUL BARTH (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BARTH
Last Name:GILMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LANCASTER AVE
Mailing Address - Street 2:MAIN LINE ONCOLOGY HEMATOLOGY ASSOCIATES
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-645-2494
Mailing Address - Fax:610-645-4456
Practice Address - Street 1:100 LANCASTER AVE
Practice Address - Street 2:MAIN LINE ONCOLOGY HEMATOLOGY ASSOCIATES
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-645-2494
Practice Address - Fax:610-645-4456
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024195E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1748215OtherCIGNA
2128658OtherAETNA
PA0008109220001Medicaid
900002735OtherUNITED
PA000038595OtherBLUE CROS PPO
23000687001OtherPRUDENTIAL
1748215OtherCIGNA
PA000038595OtherBLUE CROS PPO
2128658OtherAETNA