Provider Demographics
NPI:1609821032
Name:GURWITZ, JERRY H (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:H
Last Name:GURWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR ATTN: PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:35 MILLBURY ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-3203
Practice Address - Country:US
Practice Address - Phone:508-721-1172
Practice Address - Fax:805-832-0859
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53907207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3051021Medicaid
0401730OtherEVERCARE
3051021OtherMEDICAID/WELFARE
991173OtherFALLON CUMMUNITY HEALTH P
4292176OtherCIGNA HEALTH PLAN
784143OtherMVP HEALTH CARE
7845148OtherAETNA/US HEALTHCARE
AA1207OtherHARVARD PILGRIM HEALTHCAR
J08885OtherBLUE CARE ELECT
J08885OtherBLUE SHIELD HMO BLUE
1060701OtherFIRST HEALTH
J08885OtherBLUE SHIELD INDEMNITY
26895OtherHEALTHY START
26895OtherCHILDRENS MEDICAL SECURIT
784143OtherMVP HEALTH CARE
AA1207OtherHARVARD PILGRIM HEALTHCAR