Healthcare Provider Details

I. General information

NPI: 1902957905
Provider Name (Legal Business Name): KIBIBI GAUGHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FAIRVIEW CIR
LEBANON PA
17042-9581
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-279-7303
  • Fax: 717-279-7471
Mailing address:
  • Phone: 717-259-7303
  • Fax: 717-279-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD440939
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number226201
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: