Provider Demographics
NPI:1174634455
Name:ALLERGY & ASTHMA ASSOCIATES, P. S. C
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA ASSOCIATES, P. S. C
Other - Org Name:ALLERGY & ASTHMA ASSOCIATES OF THE BLUEGRASS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:859-277-9112
Mailing Address - Street 1:171 N EAGLE CREEK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1801
Mailing Address - Country:US
Mailing Address - Phone:859-277-9112
Mailing Address - Fax:859-277-7105
Practice Address - Street 1:171 N EAGLE CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1801
Practice Address - Country:US
Practice Address - Phone:859-277-9112
Practice Address - Fax:859-277-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000045611OtherANTHEM BCBS
KY000000045610OtherANTHEM BCBS
KY65920720Medicaid
KY65920720Medicaid