Provider Demographics
NPI:1043235179
Name:GATES, MICHAEL A (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:GATES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1549
Mailing Address - Country:US
Mailing Address - Phone:724-284-4060
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:127 ONEIDA VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2252
Practice Address - Country:US
Practice Address - Phone:866-620-6761
Practice Address - Fax:724-282-3043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001660L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077850GK7Medicare ID - Type Unspecified
PAP91275Medicare UPIN