Healthcare Provider Details

I. General information

NPI: 1073552147
Provider Name (Legal Business Name): ELLIOT MARK GERBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE MEDICAL OFFICE BLDG II - SUITE 328
PAOLI PA
19301-1763
US

IV. Provider business mailing address

207 N BROAD ST 3RD FLR
PHILADELPHIA PA
19107-1500
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-2400
  • Fax: 610-647-3902
Mailing address:
  • Phone: 267-479-4165
  • Fax: 215-463-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD038356E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD038356E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: