Provider Demographics
NPI:1407940323
Name:FLAXENBURG, GARY MICHEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHEAL
Last Name:FLAXENBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MERBROOK LANE
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066
Mailing Address - Country:US
Mailing Address - Phone:610-667-9740
Mailing Address - Fax:
Practice Address - Street 1:385 W. LANCASTER AVENUE
Practice Address - Street 2:HAVERFORD SQUARE SUITE 207
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041
Practice Address - Country:US
Practice Address - Phone:610-645-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 022773E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
079179Medicare ID - Type Unspecified
E 63522Medicare UPIN