Provider Demographics
NPI:1265473326
Name:GORSUCH, STEVEN MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MATTHEW
Last Name:GORSUCH
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 1:121 NORTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1809
Mailing Address - Country:US
Mailing Address - Phone:330-633-1352
Mailing Address - Fax:330-633-6068
Practice Address - Street 1:121 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1809
Practice Address - Country:US
Practice Address - Phone:330-633-1352
Practice Address - Fax:330-633-6068
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075053G207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201183Medicaid
OHGO4034383Medicare ID - Type UnspecifiedGREEN
OHH25878Medicare UPIN
OH2201183Medicaid
OHGO4034387Medicare ID - Type UnspecifiedMONTROSE