Provider Demographics
NPI:1346261955
Name:STRATIS GAYNER PLASTIC SURGERY
Entity Type:Organization
Organization Name:STRATIS GAYNER PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:STRATIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-728-1700
Mailing Address - Street 1:10 CAPITAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110
Mailing Address - Country:US
Mailing Address - Phone:717-728-1700
Mailing Address - Fax:717-728-1701
Practice Address - Street 1:10 CAPITAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110
Practice Address - Country:US
Practice Address - Phone:717-728-1700
Practice Address - Fax:717-728-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA472685Medicare ID - Type UnspecifiedPROFESSIONAL CORPORATION