Healthcare Provider Details

I. General information

NPI: 1629119979
Provider Name (Legal Business Name): GARY WRIGHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GARY WRIGHT M.D.

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MARKET WAY
MT. POCONO PA
18344-3842
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-839-3633
  • Fax:
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD438076
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: