Gillum, Diane
Gillum, Diane is an individual health care provider with primary practice located at 2 Cooper Plaza, 400 Haddon Ave , Camden NJ 08103-1461. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Gillum, Diane can be contacted via phone (855) 632-2667.Contact Information
Primary practice address
2 Cooper Plaza, 400 Haddon Ave
Camden NJ 08103-1461
Phone: (855) 632-2667
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 25MA04930700 | New Jersey |
Profile Details
| NPI number | 1174511091 |
|---|---|
| LBN Legal business name | Gillum, Diane |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 13th, 2005 |
| Last updated | Oct 5th, 2020 - about 5 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 | 1174511091 | NPPES |
| New Jersey | MEDICAID | 2395207 |
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