Provider Demographics
NPI:1720023112
Name:GORLIN, JED (MD)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:
Last Name:GORLIN
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 1:737 PELHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1739
Mailing Address - Country:US
Mailing Address - Phone:651-332-7284
Mailing Address - Fax:651-332-7025
Practice Address - Street 1:737 PELHAM BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1739
Practice Address - Country:US
Practice Address - Phone:651-332-7284
Practice Address - Fax:651-332-7025
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39988207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN032170100Medicaid
D88478Medicare UPIN