Provider Demographics
NPI:1275519704
Name:GERALD D VERDI DDS MD PLLC
Entity Type:Organization
Organization Name:GERALD D VERDI DDS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:VERDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:502-895-5555
Mailing Address - Street 1:4121 DUTCHMANS LN
Mailing Address - Street 2:STE 311
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4707
Mailing Address - Country:US
Mailing Address - Phone:502-895-5555
Mailing Address - Fax:502-895-5550
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:STE 311
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-895-5555
Practice Address - Fax:502-895-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166452086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000218137OtherANTHEM FACETS
KY000000218137OtherANTHEM FACETS
KYC69507Medicare UPIN