Provider Demographics
NPI:1770583379
Name:GEVIRTZ, JEFFREY L (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:GEVIRTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5018 MEDICAL CENTER CIRCLE
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9661
Mailing Address - Country:US
Mailing Address - Phone:484-876-5649
Mailing Address - Fax:610-432-6562
Practice Address - Street 1:5018 MEDICAL CENTER CIRCLE
Practice Address - Street 2:SUITE 101B
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9661
Practice Address - Country:US
Practice Address - Phone:484-876-5649
Practice Address - Fax:610-432-6562
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044999L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001692350Medicaid
PA50075237OtherCAPITAL BLUE CROSS
PAE93397Medicare UPIN
PA126650Medicare PIN