Provider Demographics
NPI:1568694610
Name:GERHOLD, MICHAEL (RT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GERHOLD
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MAGNOLIA GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-9520
Mailing Address - Country:US
Mailing Address - Phone:972-834-6759
Mailing Address - Fax:
Practice Address - Street 1:50 MAGNOLIA GARDENS DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-9520
Practice Address - Country:US
Practice Address - Phone:972-834-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1168247100000X
MSMRT4610247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist