Provider Demographics
NPI:1407820194
Name:PARADA, GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:PARADA
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 1:130 VANN ST NE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7250
Mailing Address - Country:US
Mailing Address - Phone:770-425-1341
Mailing Address - Fax:770-428-6484
Practice Address - Street 1:130 VANN ST NE
Practice Address - Street 2:SUITE 230
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7250
Practice Address - Country:US
Practice Address - Phone:770-425-1341
Practice Address - Fax:770-428-6484
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044051207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDGGWMedicare PIN
F63211Medicare UPIN