Active NPI
Mary L. Gavin, MD
- Pediatrics Physician
- Newton Square, PA
National Provider Identifier
1881784528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD418266
- Practice address
- 3855 West Chester Pike, Suite 280
Nemours Dupont Pediatrics, Newton Square
Newton Square, PA 19073-2304 - Phone
- (610) 557-4800
- Fax
- (302) 651-4945
- NPI assigned
- Oct 13, 2006
- Last updated
- Oct 3, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C10006711 | DE | |
| Pediatrics Physician | 208000000X | MD418266 | PA | Primary |
Addresses
Primary practice location
3855 West Chester Pike, Suite 280
Nemours Dupont Pediatrics, Newton Square
Newton Square, PA 19073-2304
Mailing address
PO Box 191
Provider Enrollment Dept
Rockland, DE 19732-0191
Phone (302) 651-6212
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36790 | Medicaid | NJ | |
| 4053079 | Medicaid | MD | |
| 101018361 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C10006711 | DE | MD | Pediatrics Physician |
| MD418266 | PA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412294400000",
"number": "1881784528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191",
"address_2": "PROVIDER ENROLLMENT DEPT",
"city": "ROCKLAND",
"state": "DE",
"postal_code": "197320191",
"telephone_number": "302-651-6212",
"fax_number": "302-651-4945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3855 WEST CHESTER PIKE, SUITE 280",
"address_2": "NEMOURS DUPONT PEDIATRICS, NEWTON SQUARE",
"city": "NEWTON SQUARE",
"state": "PA",
"postal_code": "190732304",
"telephone_number": "610-557-4800",
"fax_number": "302-651-4945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "MARY",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-13",
"last_updated": "2014-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "DE",
"license": "C10006711",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD418266",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36790",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4053079",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101018361",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newton Square, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.