Provider Demographics
NPI:1003929555
Name:GERSTEN, MARK H (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:H
Last Name:GERSTEN
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 1:20800 HARVARD RD
Mailing Address - Street 2:2ND FLR
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3909 ORANGE PL
Practice Address - Street 2:STE 2100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4478
Practice Address - Country:US
Practice Address - Phone:216-896-1800
Practice Address - Fax:216-896-1801
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058857207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0807569Medicaid
OH0807569Medicaid
OHE75575Medicare UPIN