MEDICARE: DR. HERMAN IVORY MCGILL MD

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	207R00000X	Internal Medicine Physician	MD024830E	PA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD024830E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558443283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERMAN IVORY MCGILL MD

Provider Business Mailing Address
First Line	:	923 MAC DADE BLVD
Second Line	:
City	:	COLLINGDALE
State	:	PA
Zip	:	19023
Country	:	US
Telephone Number	:	610-522-1222
Fax Number	:	610-532-3918

Provider Business Practice Location Address
First Line	:	923 MAC DADE BLVD
Second Line	:
City	:	COLLINGDALE
State	:	PA
Zip	:	19023
Country	:	US
Telephone Number	:	610-522-1222
Fax Number	:	610-532-3918

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/20/2010

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