Provider Demographics
NPI:1932192739
Name:GERBER, WALTER L (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:L
Last Name:GERBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 OLD YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3030
Mailing Address - Country:US
Mailing Address - Phone:215-455-2345
Mailing Address - Fax:215-455-9366
Practice Address - Street 1:5401 OLD YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3030
Practice Address - Country:US
Practice Address - Phone:215-455-2345
Practice Address - Fax:215-455-9366
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033211E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000248Medicaid
PA32475OtherAETNA HMO
PA0053487000OtherKEYSTONE HEALTH PLAN, E
PA104662OtherHIGHMARK BS/PA
PA46957OtherKEYSTONE MERCY HP
PA0053487000OtherKEYSTONE HEALTH PLAN, E
PA104662OtherHIGHMARK BS/PA