Provider Demographics
NPI:1467413336
Name:GISH, MARTIN S (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:S
Last Name:GISH
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:PO BOX 1281
Mailing Address - Street 2:GOOD SAMARITAN HOSPITAL
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1281
Mailing Address - Country:US
Mailing Address - Phone:717-270-7740
Mailing Address - Fax:717-270-3877
Practice Address - Street 1:4TH & WALNUT ST
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-1281
Practice Address - Country:US
Practice Address - Phone:717-270-7740
Practice Address - Fax:717-270-3877
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031673E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA89974OtherHIGHMARK BLUE SHIELD
PA0010006960006Medicaid
PA01523202OtherCAPITAL BLUE CROSS
PA89974Medicare ID - Type Unspecified
PA089974KAGMedicare PIN
B35430Medicare UPIN