Provider Demographics
NPI:1376848069
Name:TODD M GERLACH MD INC
Entity Type:Organization
Organization Name:TODD M GERLACH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-0144
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:150
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-540-0144
Mailing Address - Fax:310-792-3802
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:150
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-540-0144
Practice Address - Fax:310-792-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62886208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62886OtherMEDICAL BOARD OF CA
CAG66899Medicare UPIN