Provider Demographics
NPI:1205829488
Name:GERLACH, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:GERLACH
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 1:5778 DARROW RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3808
Mailing Address - Country:US
Mailing Address - Phone:330-655-2161
Mailing Address - Fax:330-650-2116
Practice Address - Street 1:5778 DARROW RD
Practice Address - Street 2:SUITE D
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3808
Practice Address - Country:US
Practice Address - Phone:330-655-2161
Practice Address - Fax:330-650-2116
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041173G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGE0442146Medicare ID - Type Unspecified
OHA77391Medicare UPIN