Provider Demographics
NPI:1033644554
Name:GILMAN, LEE ELLIOT (MSN-AGNP, NP-C, RN)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:ELLIOT
Last Name:GILMAN
Suffix:
Gender:M
Credentials:MSN-AGNP, NP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 EASTERN AVE BLDG EAST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2734
Mailing Address - Country:US
Mailing Address - Phone:410-550-2999
Mailing Address - Fax:
Practice Address - Street 1:5200 EASTERN AVE BLDG EAST2ND
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2734
Practice Address - Country:US
Practice Address - Phone:410-550-2999
Practice Address - Fax:410-367-2442
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209821163W00000X, 363LA2200X, 363LP2300X
MDXG4336702207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD126407960Medicaid
MDR209821OtherMARYLAND BOARD OF NURSING LICENSE
MDR209821OtherMARYLAND BOARD OF NURSING LICENSE
XG4336702OtherDEA BUPRENORPHINE WAIVER