Provider Demographics
NPI:1477591584
Name:GATES, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GATES
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 1:304 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3374
Mailing Address - Country:US
Mailing Address - Phone:717-299-6371
Mailing Address - Fax:717-945-1587
Practice Address - Street 1:802 NEW HOLLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2288
Practice Address - Country:US
Practice Address - Phone:717-299-6371
Practice Address - Fax:717-945-1587
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056576207Q00000X
PAMD056576L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000257176OtherUNISON
PA000800463OtherHIGHMARK BLUE SHIELD
PA0824181000OtherINDEPENDENCE BLUE CROSS
PA20007889OtherAMERIHEALTH MERCY
PA50082740OtherCAPITAL BLUE CROSS
PAP002756OtherGATEWAY
PA001544455 0006Medicaid
PA555763OtherAETNA
PA080100820OtherRAILROAD MEDICARE
PA39012OtherGEISINGER HEALTH PLAN
PA800463Medicare ID - Type Unspecified