Basic Information
| Provider Information | |||||||||
| NPI: | 1972564839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UBINA | ||||||||
| FirstName: | GILFRED | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 W LANCASTER AVE | ||||||||
| Address2: | FL 1 | ||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148862911 | ||||||||
| FaxNumber: | 8148868929 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CRESSON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166301141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148862911 | ||||||||
| FaxNumber: | 8148868929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 06/16/2017 | ||||||||
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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 | 207P00000X | MD417026 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | MD417026 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 001867124 | 05 | PA | MEDICAID |