Provider Demographics
NPI:1457490211
Name:GERHART, CORINNE DENISE (DO)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:DENISE
Last Name:GERHART
Suffix:
Gender:F
Credentials:DO
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-6478
Mailing Address - Fax:704-384-8220
Practice Address - Street 1:324 N MCDOWELL ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2222
Practice Address - Country:US
Practice Address - Phone:704-384-6478
Practice Address - Fax:704-384-8220
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-02128207Q00000X, 207QH0002X
FLOS9449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92761OtherBCBS
FL201841070OtherTAX ID
FL277624300Medicaid
FL277624300Medicaid