Healthcare Provider Details

I. General information

NPI: 1356303366
Provider Name (Legal Business Name): BALJIT SINGH GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 THIMBLE SHOALS BLVD A3
NEWPORT NEWS VA
23606-2576
US

IV. Provider business mailing address

703 THIMBLE SHOALS BLVD A3
NEWPORT NEWS VA
23606-2576
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-3401
  • Fax: 757-223-1165
Mailing address:
  • Phone: 757-873-3401
  • Fax: 757-223-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101036840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: