Provider Demographics
NPI:1801881792
Name:SISBARRO, GAYLE B (DO)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:B
Last Name:SISBARRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MANHEIM PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3127
Mailing Address - Country:US
Mailing Address - Phone:717-869-4689
Mailing Address - Fax:
Practice Address - Street 1:1160 MANHEIM PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3127
Practice Address - Country:US
Practice Address - Phone:717-869-4689
Practice Address - Fax:717-869-4690
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006214L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02994401OtherCAPITAL BLUE CROSS
PA37180 S1QBOtherGEISINGER HEALTH PLAN
PA4573072OtherAETNA NON-HMO
PA532477OtherHIGHMARK BLUE SHIELD
PA001223118Medicaid
PA578228OtherAETNA HMO
PAB43285OtherHEALTH ASSURANCE
PAP002628OtherGATEWAY HEALTH PLAN
PAB42385Medicare UPIN
PA532477JZEMedicare PIN