Provider Demographics
NPI:1588601736
Name:GEARHART, COLEEN (NP)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:GEARHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 QUADRAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8375
Mailing Address - Country:US
Mailing Address - Phone:330-336-2800
Mailing Address - Fax:
Practice Address - Street 1:8834 LAKE RD
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9001
Practice Address - Country:US
Practice Address - Phone:330-769-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07395207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2490862Medicaid
OHP00067696OtherRAILROAD MEDICARE
OHMENP14081Medicare PIN
OH2490862Medicaid