Provider Demographics
NPI:1366598971
Name:GILDEA, JACOB (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:GILDEA
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:PO BOX 536003
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15253-5902
Mailing Address - Country:US
Mailing Address - Phone:800-475-6236
Mailing Address - Fax:843-497-9566
Practice Address - Street 1:100 S 2ND ST
Practice Address - Street 2:STE 301
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2545
Practice Address - Country:US
Practice Address - Phone:717-782-3340
Practice Address - Fax:717-782-5352
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-441990207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025892300001Medicaid
PAP00939323OtherRAILROAD MEDICARE PTAN
PA219582GO3Medicare PIN