Healthcare Provider Details

I. General information

NPI: 1578673208
Provider Name (Legal Business Name): GERALD E DWORKIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FAULKE RD SUITE 200
WILMINGTON DE
19803
US

IV. Provider business mailing address

1503 LANSDOWNE AVE
DARBY PA
19023
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-5006
  • Fax: 610-237-4138
Mailing address:
  • Phone: 610-237-5006
  • Fax: 610-237-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS004891L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: