Provider Demographics
NPI:1104211721
Name:GASKILL, ZACHARY JAMES
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:GASKILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 HAMILTON WALK
Mailing Address - Street 2:1 JOHN MORGAN BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4799
Mailing Address - Country:US
Mailing Address - Phone:215-898-9095
Mailing Address - Fax:
Practice Address - Street 1:3620 HAMILTON WALK
Practice Address - Street 2:1 JOHN MORGAN BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4799
Practice Address - Country:US
Practice Address - Phone:215-898-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine