Basic Information
| Provider Information | |||||||||
| NPI: | 1477591584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176033374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172996371 | ||||||||
| FaxNumber: | 7179451587 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 NEW HOLLAND AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172996371 | ||||||||
| FaxNumber: | 7179451587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 03/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD056576 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD056576L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000257176 | 01 | PA | UNISON | OTHER | 000800463 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0824181000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 20007889 | 01 | PA | AMERIHEALTH MERCY | OTHER | 50082740 | 01 | PA | CAPITAL BLUE CROSS | OTHER | P002756 | 01 | PA | GATEWAY | OTHER | 001544455 0006 | 05 | PA | MEDICAID | 555763 | 01 | PA | AETNA | OTHER | 080100820 | 01 | PA | RAILROAD MEDICARE | OTHER | 39012 | 01 | PA | GEISINGER HEALTH PLAN | OTHER |