Organization
GARY T BROTHERSON MD INC
Active
Organization
GARY T BROTHERSON MD INC
Active
Other names
Niagara Eye Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI PISCITELLI (BILLING ADMIN.)
(814) 455-8004
Entity
Organization
Contact information
Practice address
1801 W 8TH ST, ERIE, PA 16505-4938
(814) 455-8004
(814) 456-6054
Mailing address
1801 W 8TH ST, ERIE, PA 16505-4938
(814) 455-8004
(814) 456-6054
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD030604E
PA
207W00000X
Ophthalmology Physician
OS010267L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009730980001
—
PA
01
—
060638
PTAN
PA
01
—
062849
FATICA
PA
01
—
071671
BROTHERSON
PA
05
—
1011674140001
—
PA
01
—
1444836
HIGHMARK MEDICAL GTB/FAF
PA
01
—
1821062662
FATICA NPI
PA
01
—
1932173754
BROTHERSON NPI
PA
01
—
MD030604E
BROTHERSON LICENSE
PA
01
—
OS010267L
FATICA LICENSE
PA
Enumeration date
07/08/2006
Last updated
01/21/2011
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