Provider Demographics
NPI:1174839401
Name:HEREDIA MELERO, GERARDO MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:MANUEL
Last Name:HEREDIA MELERO
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 1:125 E MAXWELL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UK OBGYN
Practice Address - Street 2:125 E. MAXWELL STREET
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508
Practice Address - Country:US
Practice Address - Phone:859-323-0005
Practice Address - Fax:859-323-0790
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50803207VF0040X, 207VF0040X
IA41217207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100488350Medicaid