Provider Demographics
NPI:1821058520
Name:GIBSON, SARAH A (PAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:OBLENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2374
Mailing Address - Country:US
Mailing Address - Phone:717-544-6111
Mailing Address - Fax:717-544-2625
Practice Address - Street 1:540 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2374
Practice Address - Country:US
Practice Address - Phone:717-544-6111
Practice Address - Fax:717-544-2625
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118571OtherAETNA
PA50012708OtherBLUE CROSS
PA210103OtherHEALTHAMERICA/HEALTHASSUR
PA210103OtherHEALTHAMERICA/HEALTHASSUR
PA118571OtherAETNA