Provider Demographics
NPI:1073771267
Name:GIBILTERRA, VIRGIL J (MS)
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:J
Last Name:GIBILTERRA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BANGOR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-3203
Mailing Address - Country:US
Mailing Address - Phone:717-649-2925
Mailing Address - Fax:
Practice Address - Street 1:7176 REDTOP RD
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9563
Practice Address - Country:US
Practice Address - Phone:717-649-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-25
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health