Provider Demographics
NPI:1487987475
Name:GIL, MICHAEL ADAM (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:GIL
Suffix:
Gender:M
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 1:4092 FOXWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5225
Mailing Address - Country:US
Mailing Address - Phone:973-902-3987
Mailing Address - Fax:
Practice Address - Street 1:300 E WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1229
Practice Address - Country:US
Practice Address - Phone:336-890-3822
Practice Address - Fax:336-663-5367
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10150363A00000X
VA0110004452363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program