Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0101048068 | VA |
NPI | 1073541736 |
---|---|
Provider Name | Steven Lloyd Gershon |
First Address | Virginia Beach, VA 23454-2402 |
Second Address | Virginia Beach, VA 23454-2402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 29/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073541736 | (05) | VA |
17203 | SENTARA/ OPTIMA (01) | VA |
2300055 | UNITED HEALTH CARE (01) | |
279949 | ANTHEM (01) | VA |
285460178 | TRICARE (01) | |
6668240001 | MEDICARE NSC (01) | |
690616G | (05) | NC |
F43232 | (02) | VA |
P00420531 | MEDICARE RAILROAD (01) | VA |