Provider Demographics
NPI:1639620420
Name:COLLEEN GERG, MA, RDN
Entity Type:Organization
Organization Name:COLLEEN GERG, MA, RDN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RDN, LDN
Authorized Official - Phone:202-497-4202
Mailing Address - Street 1:800 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1817
Mailing Address - Country:US
Mailing Address - Phone:202-497-4202
Mailing Address - Fax:
Practice Address - Street 1:800 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1817
Practice Address - Country:US
Practice Address - Phone:202-497-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004713305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service