Provider Demographics
NPI:1881637577
Name:GAVIN, MONICA C (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:GAVIN
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 1:3067 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2261
Mailing Address - Country:US
Mailing Address - Phone:610-530-0151
Mailing Address - Fax:610-625-3003
Practice Address - Street 1:17 N 3RD ST
Practice Address - Street 2:
Practice Address - City:COPLAY
Practice Address - State:PA
Practice Address - Zip Code:18037-1524
Practice Address - Country:US
Practice Address - Phone:610-200-8183
Practice Address - Fax:610-530-0151
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061743L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1637311Medicaid
PA968579OtherHIGHMARK INDV NUMBER
PA968579OtherHIGHMARK INDV NUMBER
PAG18355Medicare UPIN