Provider Demographics
NPI:1093887200
Name:GAUNA-ESTRADA, MARIBELLE (MD)
Entity Type:Individual
Prefix:
First Name:MARIBELLE
Middle Name:
Last Name:GAUNA-ESTRADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2009
Mailing Address - Country:US
Mailing Address - Phone:814-864-4987
Mailing Address - Fax:814-866-1130
Practice Address - Street 1:213 E 41ST ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2009
Practice Address - Country:US
Practice Address - Phone:814-864-4987
Practice Address - Fax:814-866-1130
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418267207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG62141Medicare UPIN
PA063357Medicare PIN