Provider Demographics
NPI:1942286539
Name:PALMER, GILBERT (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:PALMER
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 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:6252 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2003
Practice Address - Country:US
Practice Address - Phone:330-792-7418
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079478P207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000381140OtherANTHEM
OH001899757-0006OtherPENNSYLVANIA MEDICAID
OH000000385522OtherANTHEM
OH2271661Medicaid
OH000000028430OtherANTHEM
OH000000349348OtherANTHEM
OH001898757-0005OtherPENNSYLVANIA MEDICAID
OHPA4068604Medicare PIN
OH001898757-0005OtherPENNSYLVANIA MEDICAID
OH000000028430OtherANTHEM
OHPA4068606Medicare PIN
OH2271661Medicaid
OHP003550574Medicare PIN
OH930122252Medicare PIN
OH001899757-0006OtherPENNSYLVANIA MEDICAID