Basic Information
Provider Information | |||||||||
NPI: | 1033111927 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZUBROD | ||||||||
FirstName: | GORDON | ||||||||
MiddleName: | JOSHUA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3421 CONCORD RD | ||||||||
Address2: |   | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174029001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178512521 | ||||||||
FaxNumber: | 7178513535 | ||||||||
Practice Location | |||||||||
Address1: | 1001 S GEORGE ST | ||||||||
Address2: | BLDG MKB | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033676 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178512521 | ||||||||
FaxNumber: | 7178513535 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/11/2005 | ||||||||
LastUpdateDate: | 04/29/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD426188 | PA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 20067551 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 50071233 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 906863 | 01 | MD | CAREFIRST MD BCBS | OTHER | 9151112 | 01 | PA | AETNA | OTHER | P008123 | 01 | PA | GATEWAY-WMG | OTHER | 101966528 | 05 | PA |   | MEDICAID | 111165 | 01 | PA | GEISINGER | OTHER | 2168736 | 01 | PA | MAMSI-WMG | OTHER | 217523(FP) | 01 | PA | UNISON-WMG | OTHER | 211426 | 01 | PA | JOHNS HOPKINS | OTHER | 1980244 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |