Individual
DR. DIANE GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
2 COOPER PLAZA, 400 HADDON AVE, CAMDEN, NJ 08103-1461
(855) 632-2667
Mailing address
1 FEDERAL ST STE SW200, CAMDEN, NJ 08103-1155
(856) 356-4924
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
25MA04930700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2395207
—
NJ
Enumeration date
10/13/2005
Last updated
10/05/2020
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