Healthcare Provider Details

I. General information

NPI: 1619979333
Provider Name (Legal Business Name): DEBORAH ANN GENTILE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RENAISSANCE DR STE 105
BUTLER PA
16001-7612
US

IV. Provider business mailing address

200 RENAISSANCE DR STE 105
BUTLER PA
16001-7612
US

V. Phone/Fax

Practice location:
  • Phone: 724-256-8514
  • Fax: 724-256-9049
Mailing address:
  • Phone: 724-256-8514
  • Fax: 724-256-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD060203L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: