Provider Demographics
NPI:1083628978
Name:GERHARDSTEIN, DONNA CLAY (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:CLAY
Last Name:GERHARDSTEIN
Suffix:
Gender:F
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:166 PASADENA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2973
Practice Address - Country:US
Practice Address - Phone:859-278-0319
Practice Address - Fax:859-277-9699
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY26552207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64265523Medicaid
KY64265523Medicaid
KYK056010Medicare PIN