DRS. GEHRIS, JORDAN AND ASSOCIATES, LLC

Provider Demographics

• NPI: 1326168741
• Name: DRS. GEHRIS, JORDAN AND ASSOCIATES, LLC
• Entity Type: Organization
• Organization Name: DRS. GEHRIS, JORDAN AND ASSOCIATES, LLC
• Authorized Official - Title/Position: PRACTICE MANAGER
• Authorized Official - Prefix: MS
• Authorized Official - First Name: JANELLE
• Authorized Official - Last Name: ADOLPH
• Authorized Official - Phone: 410-879-9100
• Mailing Address - Street 1: 520 UPPER CHESAPEAKE DR
• Mailing Address - Street 2: # 206
• Mailing Address - City: BEL AIR
• Mailing Address - State: MD
• Mailing Address - Zip Code: 21014-4339
• Mailing Address - Country: US
• Mailing Address - Phone: 410-879-9100
• Mailing Address - Fax: 410-877-7437
• Practice Address - Street 1: 520 UPPER CHESAPEAKE DR
• Practice Address - Street 2: # 206
• Practice Address - City: BEL AIR
• Practice Address - State: MD
• Practice Address - Zip Code: 21014-4339
• Practice Address - Country: US
• Practice Address - Phone: 410-879-9100
• Practice Address - Fax: 410-877-7437
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-03-30
• Last Update Date: 2015-10-15

Provider Licenses

State	License ID	Taxonomies
MD	D0001704	207Y00000X
MD	D0041578	207Y00000X
MD	D0058518	207Y00000X
MD	D0063913	207Y00000X
MD	D0061509	207Y00000X
MD	D0001318	207Y00000X
MD	R094550	207Y00000X
MD	R077285	207Y00000X
MD	D76857	207Y00000X
MD	R192288	207Y00000X
MD	645	231H00000X
MD	762	231H00000X
MD	334	231H00000X
MD	00851	231H00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Single Specialty
No	231H00000X	Speech, Language and Hearing Service Providers	Audiologist		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MD	452568	Other	AETNA
MD	820120000	Medicaid
MD	KC33	Other	BLUECROSS BLUESHIELD
MD	139539ZB1M	Medicare UPIN
MD	C48949	Medicare UPIN
MD	P53758	Medicare UPIN
MD	P94722	Medicare UPIN
MD	452568	Other	AETNA
MD	C48945	Medicare UPIN
MD	519L	Medicare ID - Type Unspecified
MD	820120000	Medicaid
MD	I21561	Medicare UPIN
MD	I51426	Medicare UPIN