Provider Demographics
NPI:1285869164
Name:GILLESPIE, CARMELLA M (MD)
Entity type:Individual
Prefix:DR
First Name:CARMELLA
Middle Name:M
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:2702 NAVARRE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3223
Practice Address - Country:US
Practice Address - Phone:419-479-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046312207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4266653Medicare PIN
OHA80042Medicare UPIN
OHGI0497036Medicare PIN