MEDICARE: PITTSTON MEDICAL ASSOCIATES, LTD

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	698161	OTHER	PA	HIGHMARK BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00187	OTHER	PA	FIRST PRIORITY HEALTH
4	698161	OTHER	PA	FIRST PRIORITY LIFE INS C

General Provider Information

NPI Number	:	1447219431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PITTSTON MEDICAL ASSOCIATES, LTD

Provider Business Mailing Address
First Line	:	1099 S TOWNSHIP BLVD
Second Line	:	SUITE F
City	:	PITTSTON
State	:	PA
Zip	:	18640-3247
Country	:	US
Telephone Number	:	570-654-6759
Fax Number	:

Provider Business Practice Location Address
First Line	:	1099 S TOWNSHIP BLVD
Second Line	:	SUITE F
City	:	PITTSTON
State	:	PA
Zip	:	18640-3247
Country	:	US
Telephone Number	:	570-654-6759
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERALD P GIBBONS JR.
Credential	:	MD
Telephone Number	:	570-654-6759

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	03/23/2011

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Directions to “PITTSTON MEDICAL ASSOCIATES, LTD ” Practice Location

Language	Start Address	Practice Location

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