MEDICARE: MS. JACQUELINE MCGIBBON 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	207Q00000X	Family Medicine Physician	201443	NY
2	207Q00000X	Family Medicine Physician	MD073233L	PA

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	:	1467412742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE MCGIBBON MD

Provider Business Mailing Address
First Line	:	206 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-3006
Country	:	US
Telephone Number	:	570-424-7390
Fax Number	:	570-424-7395

Provider Business Practice Location Address
First Line	:	600 COMMERCE BLVD
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6214
Country	:	US
Telephone Number	:	570-424-7390
Fax Number	:	570-424-7395

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/27/2014

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