MEDICARE: DR. GERARD V VERNOSE 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	207Y00000X	Otolaryngology Physician	MD015406E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	075516SBC	OTHER	NJ	PTAN
2	115017KD4	OTHER	PA	PTAN

General Provider Information

NPI Number	:	1639116775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD V VERNOSE M.D.

Provider Business Mailing Address
First Line	:	1841 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2115
Country	:	US
Telephone Number	:	215-465-8800
Fax Number	:	215-465-8814

Provider Business Practice Location Address
First Line	:	1841 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2115
Country	:	US
Telephone Number	:	215-465-8800
Fax Number	:	215-465-8814

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	03/25/2015

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