Provider Demographics
NPI:1467943407
Name:PLATA, GISELLE (DO, MPH)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:PLATA
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 RACE ST UNIT 601
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1083
Mailing Address - Country:US
Mailing Address - Phone:202-573-7492
Mailing Address - Fax:205-900-2238
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:202-573-7492
Practice Address - Fax:205-900-2238
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00916802084P0800X
DCDO0350132084P0800X
VA01022078922084P0800X
PAOS0232802084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry