Provider Demographics
NPI:1811936255
Name:GATEWAY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:GATEWAY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-279-8940
Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:412-279-8940
Mailing Address - Fax:412-279-8871
Practice Address - Street 1:1100 WASHINGTON AVE
Practice Address - Street 2:STE 115
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3614
Practice Address - Country:US
Practice Address - Phone:412-279-8940
Practice Address - Fax:412-279-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001536865003Medicaid
PA0009406960003Medicaid
PA100955HW3Medicare ID - Type Unspecified
PA091370HW3Medicare ID - Type Unspecified
PA001536865003Medicaid
B36418Medicare UPIN
B39361Medicare UPIN
PA788700HW3Medicare ID - Type Unspecified
Q44700Medicare UPIN
PA0009406960003Medicaid