Provider Demographics
NPI:1902882715
Name:GINSBERG, PHILLIP C (DO)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:C
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5401 OLD YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3030
Mailing Address - Country:US
Mailing Address - Phone:215-456-1177
Mailing Address - Fax:215-457-1200
Practice Address - Street 1:5401 OLD YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3030
Practice Address - Country:US
Practice Address - Phone:215-456-1177
Practice Address - Fax:215-457-1200
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004644L174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00405846OtherRAILROAD MEDICARE
PA0045588000OtherINDEPENDENCE BLUE CROSS, PA
PA0099593520OtherAMERICHOICE
PA5228062OtherAETNA
PA447658WHUOtherMEDICARE PA
PA0009959340004Medicaid
PAD71461Medicare UPIN