Provider Demographics
NPI:1356694566
Name:GILL, JOHN MARK (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:GILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 GYPSY LN
Mailing Address - Street 2:UNIT 733
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-5460
Mailing Address - Country:US
Mailing Address - Phone:570-510-1383
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-8144
Practice Address - Fax:717-544-8140
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA002950363AM0700X
PAMA057609363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical