Provider Demographics
NPI:1881854461
Name:GILBERT, BERNADATTE GEORGA (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNADATTE
Middle Name:GEORGA
Last Name:GILBERT
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:P.O. BOX 858, MC A410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:121 NYES ROAD, SUITE A
Practice Address - Street 2:PENN STATE MEDICAL GROUP NYES ROAD - FAMILY MEDICINE I
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-657-4040
Practice Address - Fax:717-671-9038
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237498.207Q00000X
MS21700207Q00000X
PAMD460103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09120211Medicaid
MS302I081778OtherMEDICARE PTAN
MS09120211Medicaid
MSP00981372Medicare PIN