Provider Demographics
NPI:1568408748
Name:DORSHIMER, GARY W (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:DORSHIMER
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 1:727 DELANCEY ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4002
Mailing Address - Country:US
Mailing Address - Phone:215-829-3016
Mailing Address - Fax:215-829-3039
Practice Address - Street 1:727 DELANCEY STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:218-829-3523
Practice Address - Fax:215-829-6023
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027094E207RS0010X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009677600001Medicaid
B34935Medicare UPIN
PA071351Medicare PIN