1164422861 NPI number — DR. FRANK GEGWICH M.D.

Table of content: DR. FRANK GEGWICH M.D. (NPI 1164422861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164422861 NPI number — DR. FRANK GEGWICH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEGWICH
Provider First Name:
FRANK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1164422861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 E 16TH ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BERWICK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18603-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-752-5056
Provider Business Mailing Address Fax Number:
570-752-0841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 E 16TH ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-752-5056
Provider Business Practice Location Address Fax Number:
570-752-0841
Provider Enumeration Date:
07/26/2005

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: 207R00000X , with the licence number:  MD017655E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000632301/0004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0998135 . This is a "KEYSTONE HEALTH PLAN CENT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 998135 . This is a "HEALTH ONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102372 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 95628 . This is a "HEALTH AMERICA/HEALTH ASS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002649 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P003229 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11958 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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