Provider Demographics
NPI:1679778666
Name:GILMORE, ELAINE SHEILA (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:SHEILA
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3503
Mailing Address - Country:US
Mailing Address - Phone:585-364-1177
Mailing Address - Fax:585-678-9654
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD STE 150
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3503
Practice Address - Country:US
Practice Address - Phone:585-364-1177
Practice Address - Fax:585-678-9654
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248998207N00000X
CT045410207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03015785Medicaid
NYRB8929Medicare PIN