Provider Demographics
NPI:1669041232
Name:GERLOCK, ANDREW D
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:GERLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 STATE ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-9511
Mailing Address - Country:US
Mailing Address - Phone:419-515-9735
Mailing Address - Fax:
Practice Address - Street 1:81 STATE ROUTE 60
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-9511
Practice Address - Country:US
Practice Address - Phone:419-681-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide