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General NPI Number Information
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NPI Number | 1497788087
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Entity Type | Organization
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Legal Business Name | GARY T BROTHERSON MD INC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 1801 W 8TH ST
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City | ERIE
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State | PA
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Zip | 16505-4938
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Country | US
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Telephone | 814-455-8004
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Fax | 814-456-6054
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Provider Business Mailing Address
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Address Line | 1801 W 8TH ST
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City | ERIE
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State | PA
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Zip | 16505-4938
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Country | US
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Telephone | 814-455-8004
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Fax | 814-456-6054
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Authorized Official
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Title or Position | BILLING ADMIN.
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Name | MRS. LORI PISCITELLI
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Credential |
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Telephone | 814-455-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OS010267L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD030604E
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License Number State | PA
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