Provider Demographics
NPI:1538103239
Name:GUTIERREZ ABELLA, EMMELINE P (MD)
Entity Type:Individual
Prefix:
First Name:EMMELINE
Middle Name:P
Last Name:GUTIERREZ ABELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMMELINE
Other - Middle Name:P
Other - Last Name:GUTIERREZ-ABELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1290 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1248
Mailing Address - Country:US
Mailing Address - Phone:215-887-1541
Mailing Address - Fax:
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-938-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034690L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0048061000OtherKEYSTONE
PA5104303OtherAETNA
PA106332Medicare ID - Type Unspecified
PAC30278Medicare UPIN