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NPI Code Detail

MEDICARE: CHARLES BUCKLEY GILLOCK MD

MEDICARE: CHARLES BUCKLEY GILLOCK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician0101047505VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2279040OTHERVABCBS ANTHEM

General Provider Information

NPI Number : 1053309229
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES BUCKLEY GILLOCK MD
Provider Business Mailing Address
First Line : PO BOX 9007
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22906-9007
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 24 GLOUCESTER RD
Second Line :
City : STUARTS DRAFT
State : VA
Zip : 24477-3321
Country : US
Telephone Number : 540-337-3710
Fax Number : 540-337-0930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 05/26/2022

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