1437166881 NPI number — DR. STEPHEN CRAIG GILLARD MD

Table of content: DR. STEPHEN CRAIG GILLARD MD (NPI 1437166881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437166881 NPI number — DR. STEPHEN CRAIG GILLARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLARD
Provider First Name:
STEPHEN
Provider Middle Name:
CRAIG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437166881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 WASHINGTON ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-6022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-762-0471
Provider Business Mailing Address Fax Number:
781-762-8072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 HOME DEPOT DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360-2669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-732-6770
Provider Business Practice Location Address Fax Number:
508-732-6780
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  80236 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 80236 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J19168 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 28167 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3184340 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080236 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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