Provider Demographics
NPI:1124554431
Name:GERMINAL, GARDIA
Entity Type:Individual
Prefix:
First Name:GARDIA
Middle Name:
Last Name:GERMINAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 EASTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1483
Mailing Address - Country:US
Mailing Address - Phone:484-503-2424
Mailing Address - Fax:484-503-2425
Practice Address - Street 1:4379 EASTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1483
Practice Address - Country:US
Practice Address - Phone:484-503-2424
Practice Address - Fax:484-503-2425
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT212871207Q00000X
PAMD475000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine