=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134132376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW C GORSKE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 09/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 COURT ST DARTMOUTH HITCHCOCK - GASTROENTEROLOGY
-----------------------------------------------------
City | KEENE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03431-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-354-6534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 COURT ST DARTMOUTH HITCHCOCK - GASTROENTEROLOGY
-----------------------------------------------------
City | KEENE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03431-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-354-6534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | MD30032
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | M1716
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 17265
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------