Individual
JAY M. GILLENWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 296-9161
(434) 977-6068
Mailing address
1878 KERNWOOD PL, CHARLOTTESVILLE, VA 22911-8320
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101226171
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528137155
—
VA
Enumeration date
11/07/2006
Last updated
11/09/2016
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