Provider Demographics
NPI:1598875627
Name:GERRITY, DIANNE THERESA (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:THERESA
Last Name:GERRITY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:THERESA
Other - Last Name:LEROUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8519 REDLEAF LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3927
Mailing Address - Country:US
Mailing Address - Phone:407-536-7640
Mailing Address - Fax:
Practice Address - Street 1:8519 REDLEAF LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3927
Practice Address - Country:US
Practice Address - Phone:407-536-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12935208000000X
FLME102496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL145FHOtherBCBS