Healthcare Provider Details

I. General information

NPI: 1346236031
Provider Name (Legal Business Name): ROBERT CUMMINGS GILROY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 W LANCASTER AVE
BRYN MAWR PA
19010-3336
US

IV. Provider business mailing address

101 GREENWOOD AVE SUITE 150
JENKINTOWN PA
19046-2627
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-8600
  • Fax:
Mailing address:
  • Phone: 215-663-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD419526
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: