Healthcare Provider Details

I. General information

NPI: 1861482424
Provider Name (Legal Business Name): KEVIN A GINGRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216-220 N. BROAD STREET 2ND FLOOR FEINSTEIN BUILDING
PHILADELPHIA PA
19102-1121
US

IV. Provider business mailing address

230 N BROAD ST
PHILADELPHIA PA
19102-1121
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-2663
  • Fax: 215-762-4447
Mailing address:
  • Phone: 215-255-3828
  • Fax: 215-255-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD040220E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: