Provider Demographics
NPI:1447219431
Name:PITTSTON MEDICAL ASSOCIATES, LTD
Entity Type:Organization
Organization Name:PITTSTON MEDICAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-654-6759
Mailing Address - Street 1:1099 S TOWNSHIP BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3247
Mailing Address - Country:US
Mailing Address - Phone:570-654-6759
Mailing Address - Fax:
Practice Address - Street 1:1099 S TOWNSHIP BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3247
Practice Address - Country:US
Practice Address - Phone:570-654-6759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA698161OtherHIGHMARK BLUE SHIELD
PA0016959600001Medicaid
PA00187OtherFIRST PRIORITY HEALTH
PA698161OtherFIRST PRIORITY LIFE INS C
PA00187OtherFIRST PRIORITY HEALTH
PA698161OtherFIRST PRIORITY LIFE INS C