Healthcare Provider Details

I. General information

NPI: 1932550837
Provider Name (Legal Business Name): PAULA GILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 GOLDERS GREEN CT
WINDSOR MILL MD
21244-8083
US

IV. Provider business mailing address

2402 GOLDERS GREEN CT
WINDSOR MILL MD
21244-8083
US

V. Phone/Fax

Practice location:
  • Phone: 443-414-3082
  • Fax:
Mailing address:
  • Phone: 443-414-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number50-7499
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: