Provider Demographics
NPI:1174642359
Name:RICK GEMMA, D.O., INC.
Entity Type:Organization
Organization Name:RICK GEMMA, D.O., INC.
Other - Org Name:RICK GEMMA, D.O.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GEMMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:216-561-3838
Mailing Address - Street 1:4100 WARRENSVILLE CENTER RD
Mailing Address - Street 2:#202
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7024
Mailing Address - Country:US
Mailing Address - Phone:216-561-3838
Mailing Address - Fax:216-561-3003
Practice Address - Street 1:4100 WARRENSVILLE CENTER RD
Practice Address - Street 2:#202
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-561-3838
Practice Address - Fax:216-561-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007743G208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH25842OtherQUAL CHOICE
OH7875520OtherAETNA
OH000000334087OtherANTHEM
OH2443074Medicaid
OH25842OtherQUAL CHOICE
OH2443074Medicaid
OH2443074Medicaid
OH=========-001OtherMEDICAL MUTUAL