Provider Demographics
NPI:1649247040
Name:GATES, ZANE H (MD)
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:H
Last Name:GATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:BUILDING B 204
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4810
Mailing Address - Country:US
Mailing Address - Phone:814-201-2835
Mailing Address - Fax:814-201-2886
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:BUILDING B 204
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-201-2835
Practice Address - Fax:814-201-2886
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065714L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000001699753Medicaid
PA011194RN0Medicare PIN
PA0000001699753Medicaid