Provider Demographics
NPI:1164428660
Name:GERSTEIN, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AARON
Other - Middle Name:DAVID
Other - Last Name:GERSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8801 N MERIDIAN ST
Mailing Address - Street 2:STE 107
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2353
Mailing Address - Country:US
Mailing Address - Phone:317-848-3408
Mailing Address - Fax:
Practice Address - Street 1:8801 N MERIDIAN ST
Practice Address - Street 2:STE 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2353
Practice Address - Country:US
Practice Address - Phone:317-848-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046501A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING48900Medicare UPIN
205780Medicare ID - Type Unspecified