Provider Demographics
NPI:1669688024
Name:TASHKO, GERTI (MD)
Entity Type:Individual
Prefix:
First Name:GERTI
Middle Name:
Last Name:TASHKO
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 1:15204 OMEGA DR STE 240
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4841
Mailing Address - Country:US
Mailing Address - Phone:301-658-3586
Mailing Address - Fax:240-427-4704
Practice Address - Street 1:15204 OMEGA DR STE 240
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-658-3586
Practice Address - Fax:240-427-4704
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443090207R00000X, 207RE0101X
MDD79388207RH0005X
MDD0079388207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA417113OtherUPMC
PA30100881OtherAMERIHEALTH MERCY-WMG
PA1599272OtherGATEWAY
PA2649292OtherHIGHMARK BLUE SHIELD
PA102622218Medicaid
PA225722FLTMedicare PIN
PA30100881OtherAMERIHEALTH MERCY-WMG
PAP01001763Medicare PIN