Provider Demographics
NPI:1346419942
Name:GEORGE GERSHMAN, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GEORGE GERSHMAN, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-271-5152
Mailing Address - Street 1:9735 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2107
Mailing Address - Country:US
Mailing Address - Phone:310-271-5152
Mailing Address - Fax:310-271-5121
Practice Address - Street 1:9735 WILSHIRE BLVD
Practice Address - Street 2:SUITE 323
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2107
Practice Address - Country:US
Practice Address - Phone:310-271-5152
Practice Address - Fax:310-271-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62846207RG0100X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A628460Medicaid
CAG56501Medicare UPIN