Provider Demographics
NPI:1770515405
Name:GANDIONCO, JOHN RIZZARI (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RIZZARI
Last Name:GANDIONCO
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6400
Mailing Address - Fax:717-851-6410
Practice Address - Street 1:4020 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-3508
Practice Address - Country:US
Practice Address - Phone:717-851-6400
Practice Address - Fax:717-851-6410
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199304207R00000X
PAMD425873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101246966Medicaid
PA600732OtherHIGHMARK BLUE SHIELD
PA109460OtherJOHNS HOPKINS
MD645776OtherCAREFIRST MD BCBS
PA5946096OtherAETNA
PA100448OtherGEISINGER
PA50058820OtherCAPITAL BLUE CROSS DIM
PAP006800OtherGATEWAY-WMG
PA20055941OtherAMERIHEALTH MERCY
PA2136978OtherMAMSI-WMG
PA219494OtherUNISON SCIM
PA50071951OtherCAPITAL BLUE CROSS SCIM
PA183153OtherUNISON-WMG DIM
PA109460OtherJOHNS HOPKINS
PA101246966Medicaid
PA091127FLTMedicare PIN