Gilliam, Timothy W
Gilliam, Timothy W is an individual health care provider with primary practice located at 1571 Washington Street Suite 201, Watertown NY 13601. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Gilliam, Timothy W can be contacted via phone (315) 782-1650.Contact Information
Primary practice address
1571 Washington Street Suite 201
Watertown NY 13601
Phone: (315) 782-1650
Fax: (315) 788-8547
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 029490 | New York |
Profile Details
| NPI number | 1265182810 |
|---|---|
| LBN Legal business name | Gilliam, Timothy W |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 26th, 2022 |
| Last updated | Jun 23rd, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265182810 | NPPES |
| New York | MEDICAID | 07558372 |
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