Provider Demographics
NPI: | 1619979333 |
---|---|
Name: | GENTILE, DEBORAH ANN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DEBORAH |
Middle Name: | ANN |
Last Name: | GENTILE |
Suffix: | |
Gender: | F |
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: | 200 RENAISSANCE DR STE 105 |
Mailing Address - Street 2: | |
Mailing Address - City: | BUTLER |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16001-7612 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 724-256-8514 |
Mailing Address - Fax: | 724-256-9049 |
Practice Address - Street 1: | 200 RENAISSANCE DR STE 105 |
Practice Address - Street 2: | |
Practice Address - City: | BUTLER |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16001-7612 |
Practice Address - Country: | US |
Practice Address - Phone: | 724-256-8514 |
Practice Address - Fax: | 724-256-9049 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-12 |
Last Update Date: | 2020-05-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD060203L | 2080P0201X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2146261 | Medicaid | |
PA | 0017501400003 | Medicaid | |
WV | 6700525000 | Medicaid | |
PA | 830918 | Other | MEDICARE |
PA | 0017501400003 | Medicaid | |
PA | P00169737 | Medicare PIN |