Provider Demographics
NPI:1083699961
Name:GORSCH, STEFAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:MICHAEL
Last Name:GORSCH
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 PETER JEFFERSON PLACE
Practice Address - Street 2:SUITE 175
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-0001
Practice Address - Country:US
Practice Address - Phone:434-982-6900
Practice Address - Fax:434-982-8420
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051836207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110117312OtherMEDICARE RAILROAD / CULP
VA006045006Medicaid
VA005854474Medicaid
VA110117310OtherMEDICARE RAILROAD /AMC
VA006044239Medicaid
VA110096332OtherMEDICARE RAILROAD
VA110117310OtherMEDICARE RAILROAD /AMC
VA005854474Medicaid