Provider Demographics
NPI:1609870641
Name:MCAFOOS, GARY LYNN (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:MCAFOOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:103 W SAINT CLAIR ST
Mailing Address - Street 2:RM 2D
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2188
Mailing Address - Country:US
Mailing Address - Phone:814-723-2770
Mailing Address - Fax:814-723-0787
Practice Address - Street 1:103 W SAINT CLAIR ST
Practice Address - Street 2:RM 2D
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2188
Practice Address - Country:US
Practice Address - Phone:814-723-2770
Practice Address - Fax:814-723-0787
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032638E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011219220001Medicaid
PAMC159174OtherHIGHMARK BLUE SHIELD
NY00051423001OtherUNIVERA
159174E9EMedicare ID - Type Unspecified
PA0011219220001Medicaid