Provider Demographics
NPI:1295799609
Name:MAXIME G GEDEON MD PC
Entity type:Organization
Organization Name:MAXIME G GEDEON MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-386-3783
Mailing Address - Street 1:1638 BLAKESLEE BOULEVARD DR E
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9623
Mailing Address - Country:US
Mailing Address - Phone:570-386-4400
Mailing Address - Fax:570-386-4050
Practice Address - Street 1:1638 BLAKESLEE BOULEVARD DR E
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9623
Practice Address - Country:US
Practice Address - Phone:570-386-4400
Practice Address - Fax:570-386-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015959640008Medicaid
PAS47324Medicare UPIN
PAB81321Medicare UPIN
PA61430Medicare ID - Type Unspecified
PA0015959640008Medicaid