MEDICARE: GERSHON PAIN SPECIALISTS, LLC

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	0101048068	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	6668240001	OTHER		MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	279949	OTHER	VA	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871710798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERSHON PAIN SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	1133 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2402
Country	:	US
Telephone Number	:	757-496-2050
Fax Number	:	757-689-4357

Provider Business Practice Location Address
First Line	:	1133 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2402
Country	:	US
Telephone Number	:	757-496-2050
Fax Number	:	757-689-4357

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN L GERSHON
Credential	:	M.D.
Telephone Number	:	757-496-2050

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	06/29/2012

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Directions to “GERSHON PAIN SPECIALISTS, LLC ” Practice Location

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