Healthcare Provider Details

I. General information

NPI: 1972523033
Provider Name (Legal Business Name): GERRI M. MCGINNIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT ST 2ND FLOOR
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

615 CHESTNUT ST 14TH FLOOR, CENTRAL ENROLLMENT
PHILADELPHIA PA
19106-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7000
  • Fax: 215-503-7007
Mailing address:
  • Phone: 215-955-1175
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS-007064-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: