Provider Demographics
NPI:1619900461
Name:GORRA, JONA D (MD,)
Entity Type:Individual
Prefix:
First Name:JONA
Middle Name:D
Last Name:GORRA
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 1:10 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1424
Mailing Address - Country:US
Mailing Address - Phone:302-855-0915
Mailing Address - Fax:302-855-0914
Practice Address - Street 1:10 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1424
Practice Address - Country:US
Practice Address - Phone:302-855-0915
Practice Address - Fax:302-855-0914
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000818901Medicaid
DE0000818901Medicaid
G60272Medicare UPIN