1871525246 NPI number — EDWARD P GORRIE MD

Table of content: EDWARD P GORRIE MD (NPI 1871525246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871525246 NPI number — EDWARD P GORRIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORRIE
Provider First Name:
EDWARD
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871525246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320N TULIP DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-1432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-306-0330
Provider Business Mailing Address Fax Number:
610-660-1409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 CITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERION STATION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19066-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-660-1461
Provider Business Practice Location Address Fax Number:
610-660-1409
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD015650E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015843520002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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