Provider Demographics
NPI:1508899428
Name:GAUTHIER, HAROLD J (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:J
Last Name:GAUTHIER
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 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:215-612-4532
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030609E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00997741-02OtherAMERICHOICE- TORRES
PA00997741-03OtherAMERICHOICE- FRANKFORD
PA1111168OtherKEYSTONE MERCY
PA452729OtherAETNA CONTRACT
PA00997741-04OtherAMERICHOICE - BUCKS
PA0009977410009Medicaid
PA20045128OtherAMERIHEALTH MERCY
PA0009977410007Medicaid
PA0058423000OtherKEYSTONE IBC
PA07645OtherHEALTH PARTNERS
PA086062OtherHIGHMARK BLUE SHIELD
PA086062OtherPERSONAL CHOICE
PA5655559OtherCIGNA
PA0009977410008Medicaid
PA20045128OtherAMERIHEALTH MERCY
PA086062JL1Medicare PIN