Provider Demographics
NPI:1114961976
Name:GUMPRECHT, ERNEST CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:CHARLES
Last Name:GUMPRECHT
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 1:700 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1455
Mailing Address - Country:US
Mailing Address - Phone:419-462-4600
Mailing Address - Fax:419-462-4609
Practice Address - Street 1:629 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1821
Practice Address - Country:US
Practice Address - Phone:419-462-4600
Practice Address - Fax:419-462-4609
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132701207RC0000X
NC02143207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0257783Medicaid
SC362217Medicaid
NCP00181945OtherRR MEDICIARE
SCSC17867089OtherMEDICARE NUMBER
B63830Medicare UPIN
SC362217Medicaid