Provider Demographics
NPI:1255425435
Name:GARCIA, GERALD DION (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DION
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1442
Mailing Address - Country:US
Mailing Address - Phone:814-868-9937
Mailing Address - Fax:814-868-9841
Practice Address - Street 1:4355 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1442
Practice Address - Country:US
Practice Address - Phone:814-868-9937
Practice Address - Fax:814-868-9841
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032817-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012066630002Medicaid
PA605577Medicare ID - Type Unspecified