Provider Demographics
NPI:1659359545
Name:GAVIN, GEORGE M (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:GAVIN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:555 ROUTE 217
Practice Address - Street 2:SUITE 1
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-3428
Practice Address - Country:US
Practice Address - Phone:724-694-2723
Practice Address - Fax:724-694-8830
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD024099E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008660980004Medicaid
PA009951JDMMedicare PIN
PAB31557Medicare UPIN