Provider Demographics
NPI:1295743888
Name:GORSTEIN, FRED (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:GORSTEIN
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 1:615 CHESTNUT ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 LOCUST ST
Practice Address - Street 2:SUITE 521
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6731
Practice Address - Country:US
Practice Address - Phone:215-503-7822
Practice Address - Fax:215-503-4817
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054597L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001201030Medicaid
NJ4556607Medicaid
PA518646Medicare PIN