Provider Demographics
NPI:1790836716
Name:GATTONE, LILLIAN B (PA-C)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:B
Last Name:GATTONE
Suffix:
Gender:F
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 1:1241 BLAKESLEE BOULEVARD DR E
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2401
Mailing Address - Country:US
Mailing Address - Phone:570-386-6900
Mailing Address - Fax:570-386-6901
Practice Address - Street 1:1241 BLAKESLEE BOULEVARD DR E
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2401
Practice Address - Country:US
Practice Address - Phone:570-386-6900
Practice Address - Fax:570-386-6901
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051706363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA128531Medicare PIN