MEDICARE: DR. SONJA L CERRA-GILCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD065471L	PA
2	2085R0202X	Diagnostic Radiology Physician	25MA08165900	NJ

General Provider Information

NPI Number	:	1447239660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONJA L CERRA-GILCH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 782743
Second Line	:	ATTN: CREDENTIALING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-2743
Country	:	US
Telephone Number	:	602-910-6887
Fax Number	:	215-612-5077

Provider Business Practice Location Address
First Line	:	10800 KNIGHTS RD
Second Line	:	ATTN: RADIOLOGY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-4200
Country	:	US
Telephone Number	:	215-612-2610
Fax Number	:	215-612-5077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	01/19/2016

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