Provider Demographics
NPI:1982779278
Name:GILBERT, FREDERICK E (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:E
Last Name:GILBERT
Suffix:
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:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:GA
Mailing Address - Zip Code:30264-0695
Mailing Address - Country:US
Mailing Address - Phone:770-304-4062
Mailing Address - Fax:770-237-4539
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:NEWMAN
Practice Address - State:GA
Practice Address - Zip Code:30263
Practice Address - Country:US
Practice Address - Phone:770-304-4062
Practice Address - Fax:770-237-4539
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014049207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D39945Medicare UPIN
GA22BDDNGMedicare PIN