Provider Demographics
NPI:1376741686
Name:GERSON, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:GERSON
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3850
Practice Address - Fax:508-334-9108
Is Sole Proprietor?:No
Enumeration Date:2007-07-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1036422085R0202X
MA2341052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110079212AMedicaid
MA0044270OtherNEIGHBORHOOD HEALTH PLAN
MA5450052OtherAETNA NHMO
MA497095OtherTUFTS
MAJ42707OtherBLUE CROSS/BLUE SHIELD
MA95218201OtherNEWTORK HEALTH
MA1786121OtherAETNA HMO
FL001081600Medicaid
FL145A4OtherBCBSFL
MA5843230OtherCIGNA
MAAA114761OtherHARVARD PILGRIM
FLP00816089OtherRR MEDICARE
FLCC973YMedicare PIN
MA5843230OtherCIGNA
MA000794102Medicare PIN