Provider Demographics
NPI:1235975889
Name:GERGELY, EMILY GRACE (MPAS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GRACE
Last Name:GERGELY
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 WILLIAM PENN RD
Mailing Address - Street 2:
Mailing Address - City:IMLER
Mailing Address - State:PA
Mailing Address - Zip Code:16655-8942
Mailing Address - Country:US
Mailing Address - Phone:814-327-7309
Mailing Address - Fax:
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-889-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065699363A00000X
PAOA006915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant