William Allen Gillespie, MD
Individual provider Active NPI Pediatrics Physician · Durham, CT
NPI 1013343334 · NPPES record last updated Sep 18, 2013
Key facts
- NPI
- 1013343334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 037591 (CT)
- Practice address
- 256 Main St
Durham, CT 06422 - Phone
- (860) 349-9434
- NPI assigned
- Sep 18, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220831003880 | CT | Practitioner - Pediatric Medicine | 0143132233 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 037591 | CT | MD | Pediatrics Physician |
| 7879548 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charter Oak Health Center, Inc. | Current |
Accepting new patients | |
| Charter Oak Health Center, Inc. | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Past |
Accepting new patients |
Locations
21 Grand St
Hartford, CT 06106
Interoperability endpoints
- william.gillespie@cohc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 037591 | CT | Yes |
| Pediatrics Physician | 208000000X | 7879548 | NY |
Addresses
Primary practice location
256 Main St
Durham, CT 06422
Mailing address
256 Main St
Durham, CT 06422
Phone (860) 349-9434
Other providers in Durham, CT
- Durham Volunteer Ambulance Corps Inc
- Amy Durinick
- Empowered With Equines
- Evolve Holistic Therapy LLC
- Casey Lynn Foster
- Jason Glazer
- Brenda Griffin
- Katrina Christine Griffin
- Growth Era Counseling & Wellness, LLC
- Nazmiye Esra Hatiboglu
All providers in Durham, CT · Pediatrics Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.