Provider Demographics
NPI:1578567939
Name:GAUDIOSE, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:GAUDIOSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22 ST PAUL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1036
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 200
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6797
Practice Address - Country:US
Practice Address - Phone:301-714-4400
Practice Address - Fax:301-714-4424
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023572E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120420409OtherDEPT OF LABOR
PA247731OtherMAMSI
PA000633588 0016Medicaid
PA080087624OtherRAILROAD MEDICARE
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherINFORMED
PA122713OtherUNISON
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherINTERGROUP
PA842259OtherAETNA HMO
PA25-1716306OtherGREATWEST
PA25-1716306OtherDEVON
PA01651101OtherCAPITAL BLUECROSS
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PAMD023572EOtherLICENSE
PA4342474OtherAETNA NON-HMO
PA867633OtherMEDICARE GROUP #
PAGA152793OtherHIGHMARK BLUE SHIELD
PA1336348OtherFIRST HEALTH
PA426729OtherHEALTH AMERICA
PAP006021OtherGATEWAY
PAP006021OtherGATEWAY
PA426729OtherHEALTH AMERICA
PA867633OtherMEDICARE GROUP #