Provider Demographics
NPI:1295979334
Name:GOSLING, AMANDA LYNN (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:GOSLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:40 BERKSHIRE CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1224
Mailing Address - Country:US
Mailing Address - Phone:610-374-7400
Mailing Address - Fax:610-374-1641
Practice Address - Street 1:40 BERKSHIRE CT
Practice Address - Street 2:SUITE 1
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1224
Practice Address - Country:US
Practice Address - Phone:610-374-7400
Practice Address - Fax:610-374-1641
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2013-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD444043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027073060001Medicaid