Provider Demographics
NPI:1295831238
Name:GAIBLER, RICHARD C (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:GAIBLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:14 MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3529
Practice Address - Country:US
Practice Address - Phone:215-348-5888
Practice Address - Fax:215-348-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006629L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012476200005Medicaid
PA0012476200000Medicaid
PA0012476200000Medicaid
PA0012476200005Medicaid
PAE95413Medicare UPIN