Provider Demographics
NPI:1942273289
Name:GIBBS, RICHARD TREVOR (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TREVOR
Last Name:GIBBS
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 1:18 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8359
Mailing Address - Country:US
Mailing Address - Phone:724-261-8871
Mailing Address - Fax:
Practice Address - Street 1:18 HIGHVIEW DR
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8359
Practice Address - Country:US
Practice Address - Phone:724-261-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1145207K00000X, 208000000X
PAMD435580208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics