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NPI Code Detail

MEDICARE: DEREK GORSUCH

MEDICARE:   DEREK  GORSUCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1237700000XHearing Instrument Specialist02964OH

General Provider Information

NPI Number : 1396176442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK GORSUCH
Provider Business Mailing Address
First Line : 140 E WILLOW DR
Second Line :
City : ZANESVILLE
State : OH
Zip : 43701-1249
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2405 N COLUMBUS ST STE 140
Second Line :
City : LANCASTER
State : OH
Zip : 43130-8189
Country : US
Telephone Number : 740-652-9334
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2013
Last Update Date : 11/27/2013

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Directions to “ DEREK GORSUCH ” Practice Location

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