Provider Demographics
NPI:1477592590
Name:FROST, A GERALD
Entity Type:Individual
Prefix:
First Name:A
Middle Name:GERALD
Last Name:FROST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MAIN ST
Mailing Address - Street 2:SUITE 206, MOB 1
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-983-1715
Mailing Address - Fax:610-422-5442
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:SUITE 206, MOB 1
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-983-1715
Practice Address - Fax:610-422-5442
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027125E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00085761500012Medicaid
PA097208-008OtherCIGNA HMO/PPO
PA0001169OtherAETNA
PA00085761500012Medicaid
PA097208-008OtherCIGNA HMO/PPO