Healthcare Provider Details

I. General information

NPI: 1265954309
Provider Name (Legal Business Name): DAVID SHEPARD GILMORE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 N FRANKLIN ST
LANCASTER PA
17602-2176
US

IV. Provider business mailing address

823 RESERVE WAY
TEMPLE PA
19560-9214
US

V. Phone/Fax

Practice location:
  • Phone: 717-295-2323
  • Fax: 717-295-1349
Mailing address:
  • Phone: 860-944-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059103
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: