Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DSO36333 | PA |
NPI | 1023389905 |
---|---|
Provider Name | Dr. Rebekka Gerson |
First Address | Penn Valley, PA 19072-1232 |
Second Address | Conshohocken, PA 19428-2107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 24/01/2012 |