MEDICARE: GABRIELLE RIMA WILBY MPAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA066050	PA
2	363AM0700X	Medical Physician Assistant	MA066050	PA

General Provider Information

NPI Number	:	1063245355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE RIMA WILBY MPAS

Provider Business Mailing Address
First Line	:	2100 MACK BLVD FL 4
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-5622
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:	484-884-0699

Provider Business Practice Location Address
First Line	:	2649 SCHOENERSVILLE RD STE 101
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-7317
Country	:	US
Telephone Number	:	610-402-6986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	07/21/2025

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