Healthcare Provider Details

I. General information

NPI: 1174794564
Provider Name (Legal Business Name): STEPHANIE A GILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N PENNSYLVANIA AVE
WILKES BARRE PA
18701-3603
US

IV. Provider business mailing address

PO BOX 858
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 570-491-0126
  • Fax: 570-230-0013
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD438858
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: