Provider Demographics
NPI:1518064534
Name:MAISSEL, GERDA (MD)
Entity Type:Individual
Prefix:
First Name:GERDA
Middle Name:
Last Name:MAISSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1686
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-212-7010
Practice Address - Street 1:4900 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4824
Practice Address - Country:US
Practice Address - Phone:859-212-7000
Practice Address - Fax:859-212-7010
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80317208100000X
KYTP560208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100371820Medicaid