Organization
GATEWAY AREA MEDICAL PCP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA J NOWAK (BILLING DEPT)
(814) 371-1771
Entity
Organization
Contact information
Practice address
635C MAPLE AVE, DU BOIS, PA 15801-2377
(814) 371-1771
(814) 371-4417
Mailing address
635C MAPLE AVE, DU BOIS, PA 15801-2377
(814) 371-1771
(814) 371-4417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010511850004
—
PA
Enumeration date
04/18/2006
Last updated
12/13/2010
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