Provider Demographics
NPI:1417975384
Name:GAGIANAS, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:GAGIANAS
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 1:114 GALLERY DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:412-831-8089
Mailing Address - Fax:412-831-2955
Practice Address - Street 1:114 GALLERY DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2690
Practice Address - Country:US
Practice Address - Phone:412-831-8089
Practice Address - Fax:412-831-2955
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA044393E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00147110700015Medicaid
PA0014711070006Medicaid
PA4154OtherHEALTH AMERICA
PA0014711070002Medicaid
PA819365OtherAETNA
PA0014711070003Medicaid
PA080037733OtherRAILROAD MEDICARE
PA100771OtherUPMC
PA605277OtherHIGHMARK BC/BS
PA0014711070002Medicaid
PA00147110700015Medicaid