Healthcare Provider Details

I. General information

NPI: 1477575728
Provider Name (Legal Business Name): STEVEN GEWIRTZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 GERMANTOWN AVE
PHILADELPHIA PA
19118
US

IV. Provider business mailing address

7700 GERMANTOWN AVE
PHILADELPHIA PA
19118
US

V. Phone/Fax

Practice location:
  • Phone: 214-247-1172
  • Fax: 215-247-0663
Mailing address:
  • Phone: 214-247-1172
  • Fax: 215-247-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-038416-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: