Individual
GERALD CHARLES WYDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD STREET, TEMPLE UNIVERSITY HOSPITAL, PHILADELPHIA, PA 19140
(215) 707-5030
(215) 707-3494
Mailing address
PO BOX 8277783, TEMPLE EMERGENCY MEDICAL ASSOCIATES, PHILADELPHIA, PA 19182-7783
(215) 707-5030
(215) 707-3494
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD059816L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016558930016
—
PA
01
—
0425084000
INDEPENDENCE BC
PA
01
—
960051
HIGHMARK BS
PA
Enumeration date
03/14/2006
Last updated
01/19/2010
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