Provider Demographics
NPI:1396034757
Name:GILBERT, SCOTT E (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:GILBERT
Suffix:
Gender:M
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 1:33 BEAVER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2434
Mailing Address - Country:US
Mailing Address - Phone:814-503-8070
Mailing Address - Fax:
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-9200
Practice Address - Fax:814-375-9980
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00962411OtherRAILROAD MEDICARE
PA1269754OtherHEALTHAMERICA
PA215851MT4Medicare PIN