Provider Demographics
NPI:1467477372
Name:MO, GYI PHONE (MD)
Entity Type:Individual
Prefix:
First Name:GYI
Middle Name:PHONE
Last Name:MO
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 1:605 WEST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2620
Mailing Address - Country:US
Mailing Address - Phone:610-565-8600
Mailing Address - Fax:610-891-9238
Practice Address - Street 1:605 WEST STATE STREET
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2620
Practice Address - Country:US
Practice Address - Phone:610-565-8600
Practice Address - Fax:610-891-9238
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101443544Medicaid
PA101443544Medicaid
PAI46656Medicare UPIN