Provider Demographics
NPI:1801095369
Name:GITTENS, PAUL R JR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:GITTENS
Suffix:JR
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 1:2 BALA PLZ
Mailing Address - Street 2:PL-08
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1501
Mailing Address - Country:US
Mailing Address - Phone:610-668-8300
Mailing Address - Fax:610-668-8304
Practice Address - Street 1:2 BALA PLZ
Practice Address - Street 2:PL-08
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-668-8300
Practice Address - Fax:610-668-8304
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427582208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology