Healthcare Provider Details

I. General information

NPI: 1346419942
Provider Name (Legal Business Name): GEORGE GERSHMAN, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD SUITE 323
BEVERLY HILLS CA
90212-2107
US

IV. Provider business mailing address

9735 WILSHIRE BLVD SUITE 323
BEVERLY HILLS CA
90212-2107
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-5152
  • Fax: 310-271-5121
Mailing address:
  • Phone: 310-271-5152
  • Fax: 310-271-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA62846
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA62846
License Number StateCA

VIII. Authorized Official

Name: GEORGE GERSHMAN
Title or Position: GASTROENTEROLOGIST
Credential: M.D.
Phone: 310-271-5152