MEDICARE: LLOYD A GILGORE PSY.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	103TC0700X	Clinical Psychologist	P.S.005786L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	652400	OTHER	PA	PENNSYLVANIA BLUE SHIELD

General Provider Information

NPI Number	:	1831393222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD A GILGORE PSY.D.

Provider Business Mailing Address
First Line	:	200 NORTH ST STE A
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-3837
Country	:	US
Telephone Number	:	215-345-5245
Fax Number	:	941-697-5168

Provider Business Practice Location Address
First Line	:	200 NORTH ST STE A
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-3837
Country	:	US
Telephone Number	:	215-345-5245
Fax Number	:	941-697-5168

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/08/2007

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