Basic Information
| Provider Information | |||||||||
| NPI: | 1972551117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERSON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | GERALD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22581 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100872581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104824795 | ||||||||
| FaxNumber: | 8565283117 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E LANCASTER AVE | ||||||||
| Address2: | 353 MEDICAL OFFICE BUILDING EAST | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190963450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106499021 | ||||||||
| FaxNumber: | 6106498058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | C1-0002748 | DE | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | MD025391E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00089479 | 05 | PA | MEDICAID | 2330386000 | 01 | PA | BC/BS KEY, PER. GROUP | OTHER | 30018989 | 01 | PA | KEYSTONE MERCY GROUP | OTHER | 33659 | 01 | PA | HEALTH PARTNERS | OTHER | 3716959 | 01 | PA | AETNA US HEALTHCARE GROUP | OTHER | 4092784 | 01 | PA | AETNA US HEALTHCARE | OTHER | 0089479012 | 01 | PA | AMERICHOICE | OTHER | 119891 | 01 | PA | BC/BS HIGHMARK GROUP | OTHER | 3716980 | 01 | PA | AETNA US HEALTHCARE HMO | OTHER | 0081118000 | 01 | PA | BC/BS KEYSTONE, PERSONAL | OTHER | 30018992 | 01 | PA | KEYSTONE MERCY | OTHER | 02640 | 01 | PA | HEALTH PARTNERS | OTHER | 1652891 | 01 | PA | BC/BS HIGHMARK GROUP | OTHER | 33657 | 01 | PA | HEALTH PARTNERS | OTHER | 33658 | 01 | PA | HEALTH PARTNERS | OTHER |