Provider Demographics
NPI:1316971427
Name:GLEDHILL, LORI DAWN (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DAWN
Last Name:GLEDHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DAWN
Other - Last Name:DEJERLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3738 DAVIS STUART RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9740
Mailing Address - Country:US
Mailing Address - Phone:304-645-3207
Mailing Address - Fax:304-645-3128
Practice Address - Street 1:108 OSPREY DR STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-8556
Practice Address - Country:US
Practice Address - Phone:304-865-5101
Practice Address - Fax:304-865-5567
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466373207Q00000X
WV31011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201121530Medicaid
INP01311374Medicare PIN
IN264430146Medicare PIN