Basic Information
| Provider Information | |||||||||
| NPI: | 1144261496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILMORE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | KARI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | VA M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 FETTLER PARK | ||||||||
| Address2: | DUMFRIES HEALTH CENTER | ||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034417500 | ||||||||
| FaxNumber: | 7704618852 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 FETTLER PARK | ||||||||
| Address2: | DUMFRIES HEALTH CENTER | ||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034417500 | ||||||||
| FaxNumber: | 7704618852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 43751 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 0101251441 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00751022A | 05 | GA | MEDICAID | 02801370 | 05 | NY | MEDICAID |