Provider Demographics
NPI:1619033859
Name:HERTZ, GAIL S (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:S
Last Name:HERTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 CAROL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3857
Mailing Address - Country:US
Mailing Address - Phone:717-757-3400
Mailing Address - Fax:717-757-3702
Practice Address - Street 1:2860 CAROL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3857
Practice Address - Country:US
Practice Address - Phone:717-757-3400
Practice Address - Fax:717-757-3702
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070635L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018165000001Medicaid
PA0051195Medicare ID - Type UnspecifiedMEDICARE
PAH49070Medicare UPIN