MEDICARE: DR. GARY L. GILLEN 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	207Q00000X	Family Medicine Physician	042.0014151	VT

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

General Provider Information

NPI Number	:	1851397236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L. GILLEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 749
Second Line	:
City	:	MORRISVILLE
State	:	VT
Zip	:	05661-0749
Country	:	US
Telephone Number	:	802-851-8619
Fax Number	:	802-851-8716

Provider Business Practice Location Address
First Line	:	609 WASHINGTON HWY
Second Line	:
City	:	MORRISVILLE
State	:	VT
Zip	:	05661-8652
Country	:	US
Telephone Number	:	802-888-5639
Fax Number	:	802-888-6040

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/03/2023

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