MEDICARE: JACOB GILDEA MD

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	207ZB0001X	Blood Banking & Transfusion Medicine Physician	MD-441990	PA
2	207ZC0500X	Cytopathology Physician	MD-441990	PA
3	207ZD0900X	Dermatopathology (Pathology) Physician	MD-441990	PA
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD-441990	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00939323	OTHER	PA	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366598971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB GILDEA MD

Provider Business Mailing Address
First Line	:	PO BOX 536003
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15253-5902
Country	:	US
Telephone Number	:	800-475-6236
Fax Number	:	843-497-9566

Provider Business Practice Location Address
First Line	:	100 S 2ND ST
Second Line	:	STE 301
City	:	HARRISBURG
State	:	PA
Zip	:	17101-2545
Country	:	US
Telephone Number	:	717-782-3340
Fax Number	:	717-782-5352

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/17/2019

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Directions to “ JACOB GILDEA MD” Practice Location

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