Provider Demographics
NPI:1124201868
Name:GOSNELL, KERMIT BARRON (MD)
Entity Type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:BARRON
Last Name:GOSNELL
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 1:380105 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2317
Mailing Address - Country:US
Mailing Address - Phone:215-382-4300
Mailing Address - Fax:215-382-3972
Practice Address - Street 1:380105 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2317
Practice Address - Country:US
Practice Address - Phone:215-382-4300
Practice Address - Fax:215-382-3972
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009422E207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005447460002Medicare PIN
PAG032662Medicare Oscar/Certification
PAB33895Medicare UPIN