Provider Demographics
NPI:1831210145
Name:JAMES R. GEBHART, D.O., PC
Entity type:Organization
Organization Name:JAMES R. GEBHART, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEBHART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-981-4190
Mailing Address - Street 1:2425 GARDEN WAY
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5215
Mailing Address - Country:US
Mailing Address - Phone:724-981-4190
Mailing Address - Fax:724-981-6317
Practice Address - Street 1:2425 GARDEN WAY
Practice Address - Street 2:SUITE 100B
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5215
Practice Address - Country:US
Practice Address - Phone:724-981-4190
Practice Address - Fax:724-981-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007886L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012934350002Medicaid
PAC90870Medicare UPIN
PA0012934350002Medicaid