Healthcare Provider Details

I. General information

NPI: 1982647756
Provider Name (Legal Business Name): GARY NOTHSTEIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 N MAIN ST
SHAVERTOWN PA
18708-1121
US

IV. Provider business mailing address

610 WYOMING AVE
KINGSTON PA
18704-3702
US

V. Phone/Fax

Practice location:
  • Phone: 570-675-0900
  • Fax: 570-674-8912
Mailing address:
  • Phone: 570-288-5441
  • Fax: 570-288-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS006281L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: