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Timothy W Gilliam, PA-C
Medical Physician Assistant in Watertown, New York
NPI 1265182810

Timothy W Gilliam is a Medical Physician Assistant based in Watertown, NY and is specialized in Medical. Timothy W Gilliam practices in Watertown, NY and has the professional credentials of PA-C. The NPI Number for Timothy W Gilliam is 1265182810 and holds a License No. (New York).

The current practice location address for Timothy W Gilliam is 1571 Washington Street, Watertown, NY and can be reached out via phone at 315-782-1650 and via fax at 315-788-8547.

Location: 1571 Washington Street, Watertown, NY, 13601
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1265182810
Provider Name
Timothy W Gilliam
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
1571 Washington Street, Watertown, NY, 13601
Phone Number
315-782-1650
Fax Number
315-788-8547
Provider Enumeration Date
03/26/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
07558372 05 NY
institution
Provider Business Practice Location Address Details
Address
1571 Washington Street
City
Watertown
State
New York
Zip
13601
Phone Number
315-782-1650
Fax Number
315-788-8547
person
Provider Business Mailing Address Details
Address
1571 Washington Street
City
Watertown
State
New York
Zip
13601
Phone Number
315-782-1650
Fax Number
315-788-8547
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
029490 (New York)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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