Provider Demographics
NPI:1619931730
Name:GERSH, RICHARD NEIL I (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NEIL
Last Name:GERSH
Suffix:I
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 1:2100 KEYSTONE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1129
Mailing Address - Country:US
Mailing Address - Phone:610-394-4710
Mailing Address - Fax:610-394-4721
Practice Address - Street 1:2100 KEYSTONE AVE
Practice Address - Street 2:MEDICAL OFFICE BUILDING SUITE 206
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026
Practice Address - Country:US
Practice Address - Phone:610-394-4710
Practice Address - Fax:610-394-4721
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053611L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001589528Medicaid
PA001589528Medicaid
G30508Medicare UPIN