Provider Demographics
NPI:1073541736
Name:GERSHON, STEVEN LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LLOYD
Last Name:GERSHON
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 1:1133 FIRST COLONIAL RD.
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2402
Mailing Address - Country:US
Mailing Address - Phone:757-496-2050
Mailing Address - Fax:757-689-4357
Practice Address - Street 1:1133 FIRST COLONIAL RD.
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2402
Practice Address - Country:US
Practice Address - Phone:757-496-2050
Practice Address - Fax:757-689-4357
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010480682081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073541736Medicaid
VA17203OtherSENTARA/ OPTIMA
VA279949OtherANTHEM
NC690616GMedicaid
2300055OtherUNITED HEALTH CARE
VAP00420531OtherMEDICARE RAILROAD
6668240001OtherMEDICARE NSC
285460178OtherTRICARE
VA1073541736Medicaid
VA6668240001Medicare NSC