Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD058962L | PA |
Y | 208600000X | Surgeon | MD058962L | PA |
NPI | 1003810599 |
---|---|
Provider Name | Gerard A Garguilo |
First Address | Johnstown, PA 15905-4305 |
Second Address | Johnstown, PA 15905-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 20/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015840110003 | (05) | PA |
B66800 | (02) |