Individual provider Active NPI

Michael D Gober, MD

  • Dermatology Physician
  • Bryn Mawr, PA
National Provider Identifier
1154514131
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD443316 Issued in PA
Practice address
825 Old Lancaster Rd
Suite 320
Bryn Mawr, PA 19010-3231
Phone
(610) 527-3800
Fax
(610) 527-0334
NPI assigned
Aug 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MT190411 PA
Dermatology Physician 207N00000X MD443316 PA Primary

Addresses

Primary practice location

825 Old Lancaster Rd
Suite 320
Bryn Mawr, PA 19010-3231

Mailing address

825 Old Lancaster Rd
Suite 320
Bryn Mawr, PA 19010-3231
Phone (610) 527-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110801000596 PA Practitioner - Dermatology 9830368240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Maryland School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

825 Old Lancaster Rd
Suite 320
Bryn Mawr, PA 19010-3235
Phone (610) 527-3800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of skin lesions1694
Removal or shaving of skin growth1-10
Skin biopsy745

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD443316PAMDDermatology Physician
MT190411PAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bryn Mawr Medical Specialists Association CurrentSince Jul 1, 2015 Accepting new patients

Locations

825 Old Lancaster Rd
Ste 450
Bryn Mawr, PA 19010
Phone (610) 642-1090

825 Old Lancaster Rd
Ste 320
Bryn Mawr, PA 19010
Phone (610) 524-3800

6 E Lancaster Ave
Uppr
Wynnewood, PA 19096
Phone (484) 380-2808

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491350400000",
    "number": "1154514131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 OLD LANCASTER RD",
            "address_2": "SUITE 320",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103231",
            "telephone_number": "610-527-3800",
            "fax_number": "610-527-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 OLD LANCASTER RD",
            "address_2": "SUITE 320",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103231",
            "telephone_number": "610-527-3800",
            "fax_number": "610-527-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOBER",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2017-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MT190411",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD443316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryn Mawr, PA

Sources for this page

Verify at the official NPI Registry.