Provider Demographics
NPI:1578673208
Name:DWORKIN, GERALD E (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:DWORKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023
Mailing Address - Country:US
Mailing Address - Phone:610-237-5006
Mailing Address - Fax:610-237-4138
Practice Address - Street 1:900 FAULKE RD SUITE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:610-237-5006
Practice Address - Fax:610-237-4138
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004891L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012030800001Medicaid
PA01013952Medicaid
PA0012030800001Medicaid
PA184466JVEMedicare ID - Type Unspecified
PA01013952Medicaid