Provider Demographics
NPI:1023387834
Name:GORSUCH, JEREMY P (PA-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:P
Last Name:GORSUCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1829
Mailing Address - Country:US
Mailing Address - Phone:814-684-6341
Mailing Address - Fax:814-684-6343
Practice Address - Street 1:154 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1829
Practice Address - Country:US
Practice Address - Phone:814-684-6341
Practice Address - Fax:814-684-6343
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical