Provider Demographics
NPI:1306062575
Name:GILREATH, MARCELLUS J (MD)
Entity type:Individual
Prefix:DR
First Name:MARCELLUS
Middle Name:J
Last Name:GILREATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCELLUS
Other - Middle Name:J
Other - Last Name:GILREATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:50 TOWNSHIP RD.1012 SUITE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680
Mailing Address - Country:US
Mailing Address - Phone:740-894-1424
Mailing Address - Fax:740-894-4174
Practice Address - Street 1:50 TOWNSHIP RD.1012 SUITE B
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680
Practice Address - Country:US
Practice Address - Phone:740-894-1424
Practice Address - Fax:740-894-4174
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059795G207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2591940Medicaid
OHG26338Medicare UPIN