Provider Demographics
NPI:1063483287
Name:GERWE, ROGER A (LISW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:GERWE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12929
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-0929
Mailing Address - Country:US
Mailing Address - Phone:513-624-6550
Mailing Address - Fax:
Practice Address - Street 1:7373 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4100
Practice Address - Country:US
Practice Address - Phone:513-624-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW13323Medicare ID - Type Unspecified