Provider Demographics
NPI:1508869710
Name:GAYNER, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GAYNER
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 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:610-865-5888
Mailing Address - Fax:610-865-1697
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 602
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:610-865-5888
Practice Address - Fax:610-865-1697
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041979L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000173368901OtherUNITED HEALTHCARE
PA0013928450003Medicaid
01194801OtherCAPITAL BLUE CROSS
1522235OtherGATEWAY HEALTH PLAN
1093973OtherAMERIHEALTH MERCY
NJ0067954Medicaid
39129OtherGEISINGER HEALTH PLAN
000000129245OtherUNISON HEALTH PLAN
000725469OtherHIGHMARK BLUE SHIELD
PA0013928450003Medicaid
PA390002864Medicare PIN
01194801OtherCAPITAL BLUE CROSS
PA725469GPKMedicare PIN