Provider Demographics
NPI:1669714747
Name:FAICH, GERALD ALAN (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ALAN
Last Name:FAICH
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 1:45 E CITY AVE
Mailing Address - Street 2:SUITE 455
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2421
Mailing Address - Country:US
Mailing Address - Phone:610-969-8755
Mailing Address - Fax:
Practice Address - Street 1:45 E CITY AVE
Practice Address - Street 2:SUITE 455
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2421
Practice Address - Country:US
Practice Address - Phone:610-969-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043839L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD-043839-LOtherSTATE LICENSE