Diane Gillum, M.D

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25MA04930700 Issued in NJ

Practice address

2 Cooper Plaza, 400 Haddon Ave
Camden, NJ 08103-1461

Phone

(855) 632-2667

NPI assigned

Oct 13, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kennedy Medical Group Practice, P.C.

  • Family Medicine Physician
  • Voorhees, NJ
  • NPI 1952726796
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1174511091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FEDERAL ST STE SW200",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031155",
            "telephone_number": "856-356-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 COOPER PLAZA, 400 HADDON AVE",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031461",
            "telephone_number": "855-632-2667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1605 E Evesham Rd",
            "address_2": "Suite 2B",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080431437",
            "country_code": "US",
            "telephone_number": "856-424-8004",
            "fax_number": "856-424-8007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLUM",
        "first_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-13",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA04930700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2395207",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paris Gilchrist, LSW
• Kristen Gilgen, CRNA
• Brendan Gill, MD
• Sarika Gill, DDS
• Brendan Gilligan, MD
• Kelly Lynn Gilrain, PH.D.
• Kyle J. Gimbel, CRNA
• Taylor Lynn Gingrich, CRNP
• Shelby Elizabeth Ginsburg, PA-C
• Catherine Ginty, M.D.

• Surgery Physician in Camden, NJ
• Providers in Camden, NJ by specialty
• Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.