Provider Demographics
NPI:1720074487
Name:GEDEON, MAXIME G (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIME
Middle Name:G
Last Name:GEDEON
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:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-0271
Mailing Address - Country:US
Mailing Address - Phone:570-386-4400
Mailing Address - Fax:570-386-4050
Practice Address - Street 1:1638 BLAKESLEE BOULEVARD DR E
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9623
Practice Address - Country:US
Practice Address - Phone:570-386-4400
Practice Address - Fax:570-386-4050
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-059432-L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015959640008Medicaid
PA875476OtherBLUE SHIELD
PA875476OtherBLUE SHIELD
PA875476QXYMedicare ID - Type Unspecified