Provider Demographics
NPI:1023225968
Name:GESSNER, JONATHAN D (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:GESSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GESSNER WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-1535
Mailing Address - Country:US
Mailing Address - Phone:570-473-7017
Mailing Address - Fax:570-473-7017
Practice Address - Street 1:5 GESSNER WAY
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-1535
Practice Address - Country:US
Practice Address - Phone:570-473-7017
Practice Address - Fax:570-473-7017
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185106207Q00000X
PAMD432266207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020055190001Medicaid
PA117054W70Medicare PIN