Healthcare Provider Details

I. General information

NPI: 1689729212
Provider Name (Legal Business Name): STEPHANIE LOUISE GAILLARD MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BROADWAY ROOM 1361
BALTIMORE MD
21231
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DRIVE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3707
  • Fax: 410-955-8587
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-933-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD69970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: