Healthcare Provider Details

I. General information

NPI: 1912429739
Provider Name (Legal Business Name): GATEWAY MEDICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E MARSHALL ST STE G2
WEST CHESTER PA
19380-4400
US

IV. Provider business mailing address

412 CREAMERY WAY STE 400
EXTON PA
19341-2551
US

V. Phone/Fax

Practice location:
  • Phone: 610-431-7929
  • Fax: 610-594-2625
Mailing address:
  • Phone: 610-594-7590
  • Fax: 610-594-7597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY RODGERS
Title or Position: CEO
Credential:
Phone: 610-594-7590