Provider Demographics
NPI:1366443855
Name:GILBERT, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1503 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 3010
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1330
Mailing Address - Country:US
Mailing Address - Phone:610-237-5816
Mailing Address - Fax:610-237-5802
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 3010
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-5816
Practice Address - Fax:610-237-5802
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025745E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC32532Medicare UPIN
PA164662Medicare ID - Type Unspecified