Individual
DR. JACKIE L. GILLIARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2225 E DEFENSE HIGHWAY, CROFTON, MD 21114
(410) 721-2273
Mailing address
PO BOX 6429, ANNAPOLIS, MD 21401-0429
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D0035935
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208511900
—
MD
Enumeration date
08/08/2006
Last updated
07/08/2007
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