Provider Demographics
NPI:1679661292
Name:GIBAS, ALEXANDRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:L
Last Name:GIBAS
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 1:2104 HARRISBURG PIKE STE. 300
Mailing Address - Street 2:PO BOX 3200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604
Mailing Address - Country:US
Mailing Address - Phone:717-544-3400
Mailing Address - Fax:717-544-3400
Practice Address - Street 1:2104 HARRISBURG PIKE STE 300
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3400
Practice Address - Fax:717-544-3400
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050342L207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014308570003Medicaid
PA602617KKUMedicare ID - Type Unspecified
PA0014308570003Medicaid