Basic Information
| Provider Information | |||||||||
| NPI: | 1477046936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMELLA | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 S 10TH ST FL 10 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556000 | ||||||||
| FaxNumber: | 2159231562 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 S 10TH ST FL 10 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556000 | ||||||||
| FaxNumber: | 2159231562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2018 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MT216038 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.