Provider Demographics
NPI:1871525246
Name:GORRIE, EDWARD P (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:GORRIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320N TULIP DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1432
Mailing Address - Country:US
Mailing Address - Phone:610-306-0330
Mailing Address - Fax:610-660-1409
Practice Address - Street 1:261 CITY AVE
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1835
Practice Address - Country:US
Practice Address - Phone:610-660-1461
Practice Address - Fax:610-660-1409
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015650E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015843520002Medicaid
PA89899Medicare PIN
B38152Medicare UPIN
PAG0135345Medicare PIN