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General NPI Number Information
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NPI Number | 1871710798
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Entity Type | Organization
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Legal Business Name | GERSHON PAIN SPECIALISTS, LLC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 1133 FIRST COLONIAL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2402
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Country | US
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Telephone | 757-496-2050
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Fax | 757-689-4357
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Provider Business Mailing Address
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Address Line | 1133 FIRST COLONIAL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2402
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Country | US
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Telephone | 757-496-2050
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Fax | 757-689-4357
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN L GERSHON
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Credential | M.D.
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Telephone | 757-496-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 0101048068
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License Number State | VA
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