Provider Demographics
NPI:1588822639
Name:GERSTENMAIER, ERICA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:GERSTENMAIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1709
Mailing Address - Country:US
Mailing Address - Phone:330-535-5177
Mailing Address - Fax:330-535-5176
Practice Address - Street 1:2651 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4200
Practice Address - Country:US
Practice Address - Phone:330-864-8008
Practice Address - Fax:330-864-1207
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH0093853Medicaid
OHH226180Medicare PIN