Provider Demographics
NPI:1639116775
Name:VERNOSE, GERARD V (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:V
Last Name:VERNOSE
Suffix:
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 1:1841 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2115
Mailing Address - Country:US
Mailing Address - Phone:215-465-8800
Mailing Address - Fax:215-465-8814
Practice Address - Street 1:1841 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2115
Practice Address - Country:US
Practice Address - Phone:215-465-8800
Practice Address - Fax:215-465-8814
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015406E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075516SBCOtherPTAN
PA115017KD4OtherPTAN
NJ075516SBCOtherPTAN
PAVE115017Medicare ID - Type Unspecified