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NPI Code Detail

MEDICARE: DAVID P GORCZYCA M.D.

MEDICARE: DAVID P GORCZYCA M.D.
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
12085R0202XDiagnostic Radiology Physician7360NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2300054813OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3NV7302OTHERNVBLUE

General Provider Information

NPI Number : 1508844713
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID P GORCZYCA M.D.
Provider Business Mailing Address
First Line : 1 INDEPENDENCE PT STE 202
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-4536
Country : US
Telephone Number : 877-406-2916
Fax Number :
Provider Business Practice Location Address
First Line : 4101 WAGON TRAIL AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-4426
Country : US
Telephone Number : 702-942-4123
Fax Number : 702-942-4124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 01/11/2013

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Directions to “ DAVID P GORCZYCA M.D.” Practice Location

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