Provider Demographics
NPI:1306949607
Name:GILLIES, CAROL MACNEAL (PA-C)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:MACNEAL
Last Name:GILLIES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUXLEA CT
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6401
Mailing Address - Country:US
Mailing Address - Phone:410-825-5312
Mailing Address - Fax:
Practice Address - Street 1:2772 RUTLAND ROAD
Practice Address - Street 2:NIGHTTIME CARE CENTERS
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035
Practice Address - Country:US
Practice Address - Phone:410-721-2273
Practice Address - Fax:443-332-4265
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC 202363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP13429Medicare UPIN
MD679181NNMedicare ID - Type Unspecified