Healthcare Provider Details

I. General information

NPI: 1295754869
Provider Name (Legal Business Name): WILLIAM D GAILLARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

PO BOX 631856
BALTIMORE MD
21263-1856
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101053185
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number19882
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: