Individual
DR. BRUCE L. GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 706-1372
(410) 706-4619
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 706-1372
(410) 706-4619
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
D50956
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275583650
—
DE
05
—
182200400
—
MD
05
—
3810011136
—
WV
01
—
608175-01 & 02
BLUE CROSS/BLUE SHIELD
MD
Enumeration date
05/10/2006
Last updated
11/15/2010
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