Provider Demographics
NPI:1427096817
Name:GATRELL, CLOYD B (MD)
Entity type:Individual
Prefix:
First Name:CLOYD
Middle Name:B
Last Name:GATRELL
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 1:161 OLD SCHOOLHOUSE LN
Mailing Address - Street 2:STE 3
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5684
Mailing Address - Country:US
Mailing Address - Phone:717-691-7100
Mailing Address - Fax:717-691-6855
Practice Address - Street 1:49 PRINCE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3113
Practice Address - Country:US
Practice Address - Phone:717-901-3440
Practice Address - Fax:717-901-3447
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067632L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053541078OtherASPIRE FAMILY MEDICINE NPI
PA001894023Medicaid
1225278922OtherASPIRE HEALTH CONCEPTS NPI
1467682484OtherASPIRE URGENT CARE NPI
PA001894023Medicaid
059200Medicare ID - Type Unspecified