Provider Demographics
NPI:1093058315
Name:GOMELLA, PATRICK THEODORE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:THEODORE
Last Name:GOMELLA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 HIGHLAND AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3724
Mailing Address - Country:US
Mailing Address - Phone:215-481-7700
Mailing Address - Fax:
Practice Address - Street 1:1245 HIGHLAND AVE STE 302
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3724
Practice Address - Country:US
Practice Address - Phone:215-481-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473709208800000X
MDD0085017208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology