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: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 WAYNE AVE STE 307
INDIANA PA
15701-3501
US

IV. Provider business mailing address

1265 WAYNE AVE STE 307
INDIANA PA
15701-3501
US

V. Phone/Fax

Practice location:
  • Phone: 724-349-3290
  • Fax: 724-349-3786
Mailing address:
  • Phone: 724-349-3290
  • Fax: 724-349-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD060203L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD060203L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: