MEDICARE: DR. WILLIAM NORTHWOOD GILLELAND JR. M.D.

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
1	208600000X	Surgery Physician	MD046830L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	122440	OTHER	PA	MEDICARE ID

Other Identifiers

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

General Provider Information

NPI Number	:	1336145903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM NORTHWOOD GILLELAND JR. M.D.

Provider Business Mailing Address
First Line	:	26 NESBITT RD
Second Line	:	SUITE 151
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-3410
Country	:	US
Telephone Number	:	724-652-3616
Fax Number	:	724-656-6679

Provider Business Practice Location Address
First Line	:	26 NESBITT RD
Second Line	:	SUITE 151
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-3410
Country	:	US
Telephone Number	:	724-652-3616
Fax Number	:	724-656-6679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/10/2021

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Directions to “ DR. WILLIAM NORTHWOOD GILLELAND JR. M.D.” Practice Location

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