Provider Demographics
NPI:1245238252
Name:GAMBLE, REBECCA (PAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-464-0274
Practice Address - Street 1:850 HOSPITAL RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3662
Practice Address - Country:US
Practice Address - Phone:724-464-0270
Practice Address - Fax:724-464-0274
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003307L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
434000OtherBS#
P08882Medicare UPIN
038823Medicare ID - Type Unspecified