Provider Demographics
NPI:1912429739
Name:GATEWAY MEDICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:GATEWAY MEDICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-594-7590
Mailing Address - Street 1:412 CREAMERY WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-7597
Practice Address - Street 1:795 E MARSHALL ST STE G2
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-431-7929
Practice Address - Fax:610-594-2625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty