Healthcare Provider Details

I. General information

NPI: 1457464844
Provider Name (Legal Business Name): BALTEJ SINGH GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL DR SUITE B
HAMPTON VA
23666-1763
US

IV. Provider business mailing address

300 MEDICAL DR 2ND FLOOR
HAMPTON VA
23666-1765
US

V. Phone/Fax

Practice location:
  • Phone: 757-788-0201
  • Fax: 757-788-0950
Mailing address:
  • Phone: 757-788-0092
  • Fax: 757-788-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101034743
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: