Provider Demographics
NPI:1083668792
Name:SHOMER, GERRY L (DO)
Entity Type:Individual
Prefix:DR
First Name:GERRY
Middle Name:L
Last Name:SHOMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2883
Mailing Address - Country:US
Mailing Address - Phone:215-643-0944
Mailing Address - Fax:
Practice Address - Street 1:209 WESTMINSTER PL
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2883
Practice Address - Country:US
Practice Address - Phone:215-264-0845
Practice Address - Fax:215-233-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003048L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37381Medicare UPIN