Healthcare Provider Details

I. General information

NPI: 1710910989
Provider Name (Legal Business Name): GARY WINGATE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 CREAMERY WAY SUITE 110
EXTON PA
19341-2533
US

IV. Provider business mailing address

460 CREAMERY WAY SUITE 110
EXTON PA
19341-2533
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-8244
  • Fax: 610-524-1182
Mailing address:
  • Phone: 610-524-8244
  • Fax: 610-524-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD045027E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: