Provider Demographics
NPI:1063675783
Name:MARK A. GERARD M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARK A. GERARD M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-562-3200
Mailing Address - Street 1:201 S BUENA VISTA ST STE 250
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4520
Mailing Address - Country:US
Mailing Address - Phone:818-562-3200
Mailing Address - Fax:818-562-3205
Practice Address - Street 1:201 S BUENA VISTA ST STE 250
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4520
Practice Address - Country:US
Practice Address - Phone:818-562-3200
Practice Address - Fax:818-562-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty