Provider Demographics
NPI:1558482513
Name:ELIZABETH A. GERNHARDT INC.
Entity Type:Organization
Organization Name:ELIZABETH A. GERNHARDT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-208-5536
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0048
Mailing Address - Country:US
Mailing Address - Phone:570-313-9134
Mailing Address - Fax:570-331-9171
Practice Address - Street 1:1732 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4340
Practice Address - Country:US
Practice Address - Phone:570-331-9134
Practice Address - Fax:570-331-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009873L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018048210004Medicaid