Individual
GYI PHONE MO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
605 WEST STATE STREET, MEDIA, PA 19063-2620
(610) 565-8600
(610) 891-9238
Mailing address
605 WEST STATE STREET, MEDIA, PA 19063-2620
(610) 565-8600
(610) 891-9238
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD427335
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101443544
—
PA
Enumeration date
07/12/2006
Last updated
12/05/2012
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