Provider Demographics
NPI:1548491996
Name:GILL, NICOLE M (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:GILL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:280 S MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3112
Mailing Address - Country:US
Mailing Address - Phone:860-696-2925
Mailing Address - Fax:860-696-2926
Practice Address - Street 1:6114 FAYETTEVILLE RD STE 109
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6284
Practice Address - Country:US
Practice Address - Phone:919-942-4424
Practice Address - Fax:919-942-4440
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2020-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT649172084N0400X
NC2014-010332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology