Provider Demographics
NPI:1174541056
Name:GILWEE, JENNIFER PLANTE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PLANTE
Last Name:GILWEE
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 1:1 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7205
Mailing Address - Country:US
Mailing Address - Phone:802-847-4714
Mailing Address - Fax:
Practice Address - Street 1:1 TIMBER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7205
Practice Address - Country:US
Practice Address - Phone:802-847-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-0010023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYEO2082373Medicaid
VTONV2359Medicaid
VT42-0010023OtherSTATE LICENSE
VTVN2359Medicare ID - Type Unspecified
NYEO2082373Medicaid