Provider Demographics
NPI:1144229006
Name:GERARD, JODY (MD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:
Last Name:GERARD
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 1:8 WRIGHT ST STE 107
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3114
Mailing Address - Country:US
Mailing Address - Phone:203-895-2355
Mailing Address - Fax:
Practice Address - Street 1:8 WRIGHT ST STE 107
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3114
Practice Address - Country:US
Practice Address - Phone:203-895-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200903207P00000X
CT48064207P00000X
NY264672207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133FUMedicaid
NCE3148OtherMEDCOST #
NC133FUOtherBCBS OF NC GROUP #015CK
NC89133FUMedicaid
NCE3148OtherMEDCOST #