Provider Demographics
NPI:1447482096
Name:GILL, AMMARA TARIQ (MD)
Entity type:Individual
Prefix:
First Name:AMMARA
Middle Name:TARIQ
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMMARA
Other - Middle Name:HASSAN
Other - Last Name:TAHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 TREAT BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:
Practice Address - Street 1:400 TAYLOR BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2163
Practice Address - Country:US
Practice Address - Phone:925-677-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012019220207R00000X
CAA154333207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine