Provider Demographics
NPI:1114979754
Name:GERSTENFELD, ERIC S (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:GERSTENFELD
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 1:10790 RANCHO BERNARDO RD.
Mailing Address - Street 2:2ND FL.
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-605-7808
Mailing Address - Fax:858-605-7333
Practice Address - Street 1:15004 INNOVATION DR.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3409
Practice Address - Country:US
Practice Address - Phone:858-605-7808
Practice Address - Fax:858-605-7333
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70325207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00097867OtherRAILROAD MEDICARE
CAP00097867OtherRAILROAD MEDICARE
CAF11461Medicare UPIN
CAWC53212FMedicare PIN
CAWG70325DMedicare PIN
CABN573ZMedicare PIN
CAWC53212EMedicare PIN
CAWG70325JMedicare PIN
CAWG70325BMedicare PIN
CAWC53212CMedicare PIN
CAWG70325KMedicare PIN
CAWG70325GMedicare PIN
CAWG70325HMedicare PIN