Provider Demographics
NPI:1669460838
Name:GERBLICH, ADI ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:ADI
Middle Name:ABRAHAM
Last Name:GERBLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24755 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-464-0778
Mailing Address - Fax:216-765-1461
Practice Address - Street 1:24755 CHAGRIN BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-464-0778
Practice Address - Fax:216-765-1461
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-8470207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0709362Medicaid
OH4238642Medicare PIN
A83125Medicare UPIN
0620249Medicare PIN