Individual
CHARLES BUCKLEY GILLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 GLOUCESTER RD, STUARTS DRAFT, VA 24477-3321
(540) 337-3710
(540) 337-0930
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101047505
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007501188
—
VA
01
—
279040
BCBS ANTHEM
VA
Enumeration date
10/11/2005
Last updated
05/26/2022
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