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General NPI Number Information
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NPI Number | 1275778797
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Entity Type | Individual
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Provider Name | FENGYAN GILBERT PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 5501OLD YORK ROAD
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City | PHILADELPHIA
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State | PA
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Zip | 19141
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Country | US
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Telephone | 216-456-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 7720 NEW SECOND ST
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City | ELKINS PARK
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State | PA
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Zip | 19027-3512
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Country | US
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Telephone | 215-796-2155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA003459-L
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License Number State | PA
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