Provider Demographics
NPI:1275778797
Name:GILBERT, FENGYAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:FENGYAN
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:7720 NEW SECOND ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3512
Mailing Address - Country:US
Mailing Address - Phone:215-796-2155
Mailing Address - Fax:
Practice Address - Street 1:5501OLD YORK ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:216-456-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003459-L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP16692Medicare UPIN