Provider Demographics
NPI:1235558768
Name:PAUL GERRARD
Entity Type:Organization
Organization Name:PAUL GERRARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GERRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-292-8602
Mailing Address - Street 1:110 MARGINAL WAY # 706
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2442
Mailing Address - Country:US
Mailing Address - Phone:803-292-8602
Mailing Address - Fax:
Practice Address - Street 1:335 BRIGHTON AVE STE 201
Practice Address - Street 2:NEW ENGLAND REHABILITATION HOSPITAL
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2365
Practice Address - Country:US
Practice Address - Phone:803-292-8602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20073208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty