Healthcare Provider Details

I. General information

NPI: 1306040266
Provider Name (Legal Business Name): RICHARD MARSTON GILLESPIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 S BUENA VISTA ST FL 4
BURBANK CA
91505-4504
US

IV. Provider business mailing address

181 S BUENA VISTA ST FL 4
BURBANK CA
91505-4504
US

V. Phone/Fax

Practice location:
  • Phone: 818-748-4942
  • Fax: 818-840-7064
Mailing address:
  • Phone: 818-748-4942
  • Fax: 818-840-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number61910
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC198640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: