Provider Demographics
NPI:1114115102
Name:GERICARE ASSOCIATES INC
Entity Type:Organization
Organization Name:GERICARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHWETAL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-863-4717
Mailing Address - Street 1:5157 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2622
Mailing Address - Country:US
Mailing Address - Phone:513-863-4717
Mailing Address - Fax:
Practice Address - Street 1:5157 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2622
Practice Address - Country:US
Practice Address - Phone:513-863-4717
Practice Address - Fax:513-863-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9337721OtherMEDICARE PCAN
OH1114115102OtherMEDICARE NPI
OH2837676Medicaid
OH0705349Medicare PIN