Provider Demographics
NPI:1427031343
Name:GAMBESCIA, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:GAMBESCIA
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 1:525 JAMESTOWN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1751
Mailing Address - Country:US
Mailing Address - Phone:215-463-1483
Mailing Address - Fax:215-483-9185
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-463-1483
Practice Address - Fax:215-483-9185
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06911400207RG0100X
PAMD013566E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0641580Medicaid
NJ2353903Medicaid
PA0641580Medicaid
PA100003000Medicare PIN
B35350Medicare UPIN
PA086663EZPMedicare PIN
NJ093721TT5Medicare PIN