Provider Demographics
NPI:1235393109
Name:GERBER, LORI ILYSE (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ILYSE
Last Name:GERBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ILYSE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-633-9710
Practice Address - Street 1:5000 BENSALEM BLVD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4043
Practice Address - Country:US
Practice Address - Phone:215-638-4340
Practice Address - Fax:215-633-9710
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6131000OtherAETNA HMO
PA2130015OtherHIGHMARK BLUE SHIELD
PA1023840270001Medicaid
PA118141219OtherWORKMAN'S COMP
PA30069772OtherKEYSTONE MERCY
PA3738059000OtherKEYSTONE IBC
PA44130OS14327LOtherHEALTH PARTNERS
PA6131000OtherAETNA HMO