Provider Demographics
NPI:1528025491
Name:BENTZ, GALE L (PA-C)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:L
Last Name:BENTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17005 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4828
Mailing Address - Country:US
Mailing Address - Phone:302-703-4025
Mailing Address - Fax:302-703-4027
Practice Address - Street 1:17005 OLD ORCHARD RD STE 201
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4828
Practice Address - Country:US
Practice Address - Phone:302-703-4025
Practice Address - Fax:302-703-4027
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S67213Medicare UPIN
PA39232Medicare ID - Type Unspecified