Provider Demographics
NPI:1235181199
Name:GERSTNER, GLORIA ISABEL (DPM MS)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ISABEL
Last Name:GERSTNER
Suffix:
Gender:F
Credentials:DPM MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 LANG AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4474
Mailing Address - Country:US
Mailing Address - Phone:505-892-9700
Mailing Address - Fax:505-892-1210
Practice Address - Street 1:4801 LANG AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4474
Practice Address - Country:US
Practice Address - Phone:505-892-9700
Practice Address - Fax:505-892-1210
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1378213E00000X
NM307213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
585241041567OtherPREFERRED ONE
NM10007865Medicaid
NMNM009A43OtherBCBS
NM11647136OtherCAQH
NMNM00086OtherMEDICARE PTAN INDIVIDUAL
NMNM400263OtherMEDICARE PTAN INDIVIDUAL
215K7GEOtherBC BS
2700428OtherMEDICA
2700428OtherMEDICA
NMNMB0086Medicare PIN