Provider Demographics
NPI:1417979477
Name:LANOCE, GARY SABATINE (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SABATINE
Last Name:LANOCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-324-0134
Mailing Address - Fax:215-324-0885
Practice Address - Street 1:7602 CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2443
Practice Address - Country:US
Practice Address - Phone:215-969-2900
Practice Address - Fax:215-969-1856
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006422L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherRR MEDICARE
PA597586OtherMEDICARE GROUP
PA0011346800Medicaid
PA0011346800Medicaid
PA192502Medicare PIN