Provider Demographics
NPI:1104903608
Name:ALDERFER, GILL R (MD)
Entity type:Individual
Prefix:DR
First Name:GILL
Middle Name:R
Last Name:ALDERFER
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 1:123 MANSION DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1019
Mailing Address - Country:US
Mailing Address - Phone:610-566-5392
Mailing Address - Fax:
Practice Address - Street 1:100 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1703
Practice Address - Country:US
Practice Address - Phone:610-521-4311
Practice Address - Fax:610-521-5995
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016127E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40402Medicare UPIN
PA162865Medicare ID - Type Unspecified