Provider Demographics
NPI:1851329163
Name:GAMMIE, MELISSA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:GAMMIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4900
Mailing Address - Fax:717-259-7262
Practice Address - Street 1:105 4TH ST
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9638
Practice Address - Country:US
Practice Address - Phone:717-812-4900
Practice Address - Fax:717-259-7262
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001891L363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20019276OtherAMERIHEALTH MERCY-WMG
PA50000130OtherCAPITAL BLUE CROSS-WMG
PA1551696OtherGATEWAY-WMG
PA1916744OtherHIGHMARK FREEDOM BLUE
PA1916744OtherHIGHMARK FREEDOM BLUE
PA690802FLTMedicare PIN
PA50000130OtherCAPITAL BLUE CROSS-WMG