Healthcare Provider Details

I. General information

NPI: 1922591320
Provider Name (Legal Business Name): GILLESPIE PLASTIC AND RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2383 LIMESTONE RD 2ND FLOOR
WILMINGTON DE
19808-4130
US

IV. Provider business mailing address

2383 LIMESTONE RD 2ND FLOOR
WILMINGTON DE
19808-4130
US

V. Phone/Fax

Practice location:
  • Phone: 302-274-2996
  • Fax: 302-274-2987
Mailing address:
  • Phone: 302-274-2996
  • Fax: 302-274-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberC1-0012570
License Number StateDE

VIII. Authorized Official

Name: DR. JOHN W GILLESPIE III
Title or Position: OWNER
Credential: MD
Phone: 302-274-2996