Provider Demographics
NPI:1356969521
Name:GILMORE, ASHLEY ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3478
Mailing Address - Country:US
Mailing Address - Phone:182-623-3685
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3478
Practice Address - Country:US
Practice Address - Phone:518-262-3368
Practice Address - Fax:518-262-4902
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA2102363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical